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Health of Workers 

^ 0 

Exposed to 3 ■' 

Sodium Fluoride at 
Open Hearth Furnaces 


PUBLIC HEALTH BULLETIN NO. 299 
Prepared by direction of the Surgeon General by J. Walter 
Hough, Medical Officer; Dohrman H. Byers, Scientist; Vernon 
J. Forney, Dental Surgeon; Hugh P. Brinton, Statistician; Robert 
G. Keenan, Senior Assistant Scientist (R); Robert P. Ralls, 
Assistant Surgeon; Harold J. Paulus, Senior Assistant Scientist ( R ), 
from Industrial Hygiene Division, Bureau of State Services 



Federal Security Agency • public health service 






Health of Workers 
Exposed to 
Sodium Fluoride at 
Open Hearth Furnaces 


PUBLIC HEALTH 
Federal Security Agency 


BULLETIN NO. 299 

li.S. 

• PUBLIC HEALTH SERVICE., 

A J 


Washington, D. C. 




UNITED STATES 

GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1948 


For sale by the Superintendent of Documents, Washington, D. C. 


. . Price 25 cents 





Contents 

Page 

ABSTRACT. 1 

ORIGIN OF STUDY. 4 

ENVIRONMENTAL FINDINGS. 5 

Open-hearth process for steel. 5 

Occupational analysis and description. 6 

Instruments and methods. 10 

Air sampling. 10 

Settled dust. 12 

Chemical methods. 12 

Results of study. 15 

Observations of environment. 15 

Nature and concentration of air contaminants. 19 

Interpretation of occupational exposures. 22 

Summary of environmental findings. 23 

Conclusions from environmental findings. 24 

Recommendations from environmental findings. 25 

CHARACTERISTICS OF GROUP STUDIED. 26 

Age distribution of workers examined. 26 

Birthplace. 27 

Marital status. 28 

Personal habits. 28 

Alcohol. 28 

Tobacco. 29 

Sleep. 29 

Baths. 30 

Work experience. 31 

Previous occupational history. 31 

Experience in steel industry. 31 

MEDICAL FINDINGS. 33 

Introduction. 33 

Procedures. 35 

History and physical examination. 35 

Laboratory tests. 35 

Dispensary visits. 36 

Sick absences. 37 

Previous illnesses. 38 

History and symptoms. 39 

Physical examination. 

General discussion. 40 

Weight deviation. 40 

Eyes. 41 


III 










































MEDICAL FINDINGS—Continued 

Physical examination—Continued Pa £ e 

Visual acuity. 41 

Nose. 43 

Throat. 44 

Cardiovascular. 44 

Blood pressure. 46 

Skin. 48 

X-ray interpretations. 48 

General discussion. 48 

Granular and nodular lung-field markings. 49 

Pulmonary tuberculosis. 51 

Long-bone X-ray films. 52 

Laboratory. 52 

Blood test for syphilis. 52 

Hemoglobin determination. 52 

Blood cell counts. 52 

Urinalysis. 53 

Fluorides in urine. 53 

Summary of medical findings. 53 

Conclusions from medical findings. 54 

ORAL FINDINGS. 55 

Introduction. 55 

Clinical oral examination. 55 

General findings. 56 

Specific findings. 56 

Interpretation of findings. 57 

Summary of oral findings. 59 

Conclusions from oral findings. 59 

Recommendations from oral findings. 59 

ACKNOWLEDGMENTS. 60 

APPENDIX TABLES. 61 


IV 
































Abstract 


Summary 

The Industrial Hygiene Division of the Public Health Service was 
requested by representatives of the Republic Steel Corporation and the 
1 nited Steelworkers of America, CIO. to make a study of the potential 
health hazards which might be associated with the use of sodium 
fluoride at open-hearth furnaces. 

Field work was conducted from January 7 to February 8, 1948, in 
four Republic Steel Corp. plants in Ohio. Medical examinations were 
made of 350 males, including 24 Negroes, distributed as follows : One 
hundred and eighty-seven in two plants now using sodium fluoride, 
63 in a plant where sodium fluoride formerly was used and 100 in a 
plant which had never used sodium fluoride. 

The environmental study involved the collection of fume and gases 
in an electrostatic precipitator and standard impinger combined in 
series. A total of 149 air samples, 16 settled-dust samples and 9 
control samples, were collected. Laboratory investigations included 
determinations of the following in the air: Fluorine, total fume, 
oxides of iron, and manganese. X-ray diffractions were made of fume 
and dust. Urine samples were studied to determine their fluorine 
content. 

The medical study included a detailed occupational history, and a 
record of past diseases, operations, and injuries. Present symptoms 
were recorded with special emphasis on irritative effects of fume. A 
complete physical examination was performed with attention directed 
towards any evidence of lens opacity and inflammation of the mucous 
membranes of the eyes, nose, and throat. A 14- by 17-inch X-ray of 
the chest was taken of each worker as well as an X-ray of his left wrist 
and forearm. Urine was examined for albumin and sugar. Red and 
white blood cell counts, hemoglobin determinations, serologic tests for 
syphilis, and leucocyte differential counts were made from the blood 
of each individual. 

A clinical oral examination was made of each employee. Procedures 
used in these examinations consisted of critical inspection of all oral 


1 


tissues and structures with the aid of two posterior bite-wing X-rays 
and lateral film of the lower left jaw. 

Atmospheric concentrations of iron oxides, manganese, and total 
fume were similar in all four plants. The maximum concentrations of 
iron oxides and manganese were well within safe limits. The weighted 
exposures to total fume were rather low, although certain jobs in¬ 
volved high exposures of moderate duration. Sodium fluoride con¬ 
centrations in the two plants using it were similar in magnitude and 
had overlapping ranges. With respect to both sodium fluoride and 
total fume, the cranemen had the greatest exposure and the pouring 
platform men were second. Weighted exposures to sodium fluoride 
for these two groups were 2.2 and 0.4 milligrams of sodium fluoride 
per cubic meter of air, and for all others they were negligible. Tar 
smoke and radiant heat were noted as discomforting factors in need of 
correction. 

In the light of present information such concentrations of sodium 
fluoride would not be considered hazardous. However, brief exposures 
to the higher concentrations of total fume and dusts may irritate 
sensitive tissues of the nose, mouth, and throat. 

No significant physical defects could be directly related to the use 
of sodium fluoride. Upper respiratory symptoms such as cough were 
also not related to exposure but on the contrary occurred most com¬ 
monly in the control plant. These symptoms might be attributed to 
the total fume and dust content of the air in all plants. The labora¬ 
tory and X-ray examinations did not reveal any condition which 
might be linked to the use of sodium fluoride. From these findings, 
it would appear that sodium fluoride does not constitute a health 
hazard under the conditions of this study. 

Conclusions 

1. Concentrations of iron oxides and manganese fumes were be¬ 
low the accepted maximum allowable concentrations and it is con¬ 
cluded that they would not constitute a significant health hazard. 

2. When sodium fluoride was added to the molten steel in the 
molds or ladles, the compound was dispersed, without chemical 
change, into the working atmosphere. The weighted exposures of 
the workmen were not great enough, in the light of present informa¬ 
tion, to indicate any probable hazard or chronic toxic effects. 

3. Acridine and other factors in the smoke from mold coatings, 
during coating and pouring operations, were very irritating. 

4. Discomfort caused by radiant heat was excessive. 

5. Fumes, smoke, and dust encountered at the open hearths induce 
an upper respiratory symptom complex which may be irritating and 
annoying. 


2 


G. According to the data on symptoms by plants, there is an in¬ 
verse relationship of the symptomatology to the exposure to sodium 
fluoride. 

T. No severe pharyngeal damage results from exposure to sodium 
fluoride. A slight degree of pharyngitis may possibly be caused by 
sodium fluoride, tar smoke, or sulfur dioxide fumes; it is difficult to 
separate the effects of these three environmental factors. 

8. On a basis of physical and X-ray findings, there were no definite 
changes attributable to sodium fluoride. 

9. Exposure to sodium fluoride has little or no disabling effect on 
the tissues and structures of the oral cavity. Sodium fluoride does 
not produce tissue necrosis when introduced into the oral cavity in 
atmospheric concentrations as experienced in the occupational en¬ 
vironments which were investigated. However, sodium fluoride, in 
combination with other fumes and dusts, may be a contributing fac¬ 
tor in producing soft-tissue inflammation in the mouth. 

10. Repeated exposure to irritant factors in the occupational en¬ 
vironment may produce increased thickening on vulnerable areas of 
the oral mucosae. 

Recommendations 

1. Mold-coating operations should be controlled to avoid unnec¬ 
essarily thick coatings which result in considerable discomfort to work¬ 
men while pouring steel. 

2. A mold-coating material giving less dense and less irritating 
smoke and fume than the present coatings should be sought. 

3. Whenever possible intense exposure to radiant heat should be 
reduced or eliminated by use of protective clothing, remote controls, 
or other means. 

4. The possibility of eliminating dust, fume, smoke, and heat ex¬ 
posures of cranemen, by the use of a positive-pressure ventilating 
system with filtering of intake air, should be explored. 

5. Crane cab windows should be cleaned regularly and frequently 
to encourage the operators to keep these windows closed during peak 
exposure periods. 


3 


Origin of Study 

The use of sodium fluoride in various industries throughout the 
country has mushroomed from pounds per day in 1942 to tons per day 
at the present time. Knowledge about its toxic properties in indus¬ 
trial processes, however, has not kept pace with its expanded utiliza¬ 
tion. Numerous questions concerning its effects on health have there¬ 
fore arisen, particularly in connection with its use in open-hearth 
operations in steel mills. 

Sodium fluoride is used in the manufacture of rimmed steel because 
it helps produce an ingot whose surface is free from blowholes and 
whose skin will withstand tearing and cracking. Its use preserves the 
fluid state of molten metal and prolongs solidification reaction time, 
thus allowing for the escape of trapped gases which would otherwise 
cause blowholes in the finished product. 

Suspicion of potential health hazards inherent in the use of sodium 
fluoride has provoked much labor unrest. Workers have complained 
bitterly about its use. 

To obtain conclusive information as to the existence of possible 
hazards, representatives of the Republic Steel Corp. and the United 
Steelworkers of America, CIO, requested the Industrial Hygiene 
Division of the Public Health Service to make a thorough study. Al¬ 
though surveys of the process had been made previously by other 
agencies, they had been confined to an investigation of the working en¬ 
vironment and had not included medical and dental examinations of 
the workers involved. 

The Public Health Service accordingly undertook a survey of the 
potential health hazards which might be associated with the use of so¬ 
dium fluoride in open-hearth furnaces in four Republic Steel Corp. 
plants located in Ohio. This study was conducted between January 
7 and February 8,1948. The results of this investigation follow. 


4 


Environmental Findings 


THE OPEN-HEARTH PROCESS FOR STEEL 

As an introduction to the environmental phases of this study, a 
brief description of the open-hearth process and operations seems 
expedient. The presentation is intentionally short and general with 
possible excursions into details of particular interest. Only the pit- 
side environment was evaluated. 

The making of steel is essentially the purification of pig iron and 
scrap. The open-hearth process is one method of accomplishing this 
through the burning-out of carbon and the incorporation and removal 
of other impurities in the slag. The open-hearth furnace is a large 
rectangular brick oven with a basin-shaped hearth. A series of ver¬ 
tically sliding doors at the front faces the charge floor from which 
the raw materials are fed to the furnace. Scrap iron, limestone and 
iron ore are weighed into charging pans in the stock house. The 
charging pans are brought by rail to the charge floor and their con¬ 
tents dumped into the furnace by means of a mechanical ram-type 
charger. Molten pig iron is poured directly into the open hearth. 
The gas or oil flame is then turned on and the charge is allowed to 
melt and work. Further additions of raw materials or alloying ele¬ 
ments may be made from time to time. As the heat nears comple¬ 
tion, tests are taken to the laboratory and the melter keeps an experi¬ 
enced eye on the furnace’s contents. Wien the analysis and temper¬ 
ature are right for the desired type of steel, the heat is ready to be 
tapped. The cycle from charging to tapping requires from 10 to 14 
hours. 

The tap hole runs from the lowest point in the basin of the hearth 
out through the back of the furnace. Wien the steel is ready, a crew 
digs out the fire-clay plug and burns the hole open. The molten steel 
flows rapidly from the tap hole, along a runner and into a ladle lo¬ 
cated in the pit. Further addition of materials such as coal, sulfut*, 
ferromanganese, aluminum, and sodium fluoride may be made to the 
steel in the ladle. Less frequently alloying elements such as chromium 
and vanadium may be thus added. Bags of the materials may be 


790731 - 48 


5 



thrown into the ladle or the loose material shoveled in. The slag also 
flows into the ladle but it overflows thence into a slag thimble. When 
tapping is complete a ladle crane takes the ladleful of liquid steel away 
to be cast into ingots. 

The pouring platforms, located across the pit from the back of the 
furnaces, are about on a level with the tops of the ingot molds. The 
molds set on buggies on a railway siding alongside the platform. The 
craneman maneuvers the ladle over each mold in succession while the 
steel pourer operates the stopper to control the flow of steel from the 
nozzle. As the steel is thus cast, additional chemicals such as aluminum 
and sodium fluoride may be added to each ingot. After the pour is 
completed, the ingots are hauled away to be stripped and eventually 
rolled. 

The foregoing has not mentioned the numerous other activities of 
the charge floor and pit incidental to the actual making and casting 
of the steel. Each time a ladle has been used the skull of slag and 
steel residue must be removed and a new nozzle and stopper put in 
place. Periodically the slag and spill must be cleaned up. Most 
of these operations might be considered as routine maintenance. The 
charge floor men are responsible for keeping the furnaces in proper 
condition. 


OCCUPATIONAL ANALYSIS AND DESCRIPTIONS 

In the course of the study, it was found that job titles varied appre¬ 
ciably in their meaning from plant to plant. The same titles often 
referred to different jobs or a given job would be known by en¬ 
tirely different titles in the various plants. To prevent the confu¬ 
sion which could so easily occur in reporting on such a situation, 
the company was asked to provide a list of standard job titles and to 
correlate them to the job titles used in the individual plants. This 
information was used in the preparation of table 1. 

All of the workers included in this study are classed into four 
broad occupational groups according to the location and nature of 
their work. Group 1 consists of the crane operators whose area of 
work is mobile but rather definitely defined by the limits of the 
crane cab. In group 2 are placed all men who work with any de¬ 
gree of regularity on the pouring platform during pouring opera¬ 
tions. These men also spend considerable time in the pit. Men 
whose work is mostly confined to the pit comprise the third group. 
Into group 4 are assembled men who work in other locations and 
have limited exposures to the pit-side environment. An analysis by 
plant of the number of men in each occupation and broad grouping 
is given in table 2. 


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Column 1 lists all of the job titles as given on the medical examination schedules for all men examined at the 4 plants. 

Columns 2, 3, 1, and 5 list the standard job title corresponding to the plant titles in column 1 at each plant. The conversion of tittes was made by reference to the “Correlation 
of job titles” table furnished by the company. Blanks occur where no workers by the titles in column 1 were listed at the corresponding plant. Titles in parentheses indicate that 
no correlation of such a plant title was given and the probable best standard title is thus indicated. 
















































































Table 2 .—Broad occupational grouping oj male workers in the open-hearth 

department oj 4 steel plants 


Occupation 

Total 

Plant A 

Plant B 

Plant C 

Plant D 

Total, all occupations_ 

350 

48 

63 

139 

100 


Group 1—Cranemen 

Total_ 

56 

10 

16 

18 

12 

Ladle craneman_ 

50 

10 

16 

12 

12 

Hot metal craneman_ _ ... ._ _ 

6 

0 

0 

6 

0 


Group 2—Platform workers 

Total_ 

80 

26 

18 

20 

16 

First ladleman_ 

31 

4 

5 

12 

10 

Steel pourer... _ .. _ ... 

27 

8 

5 

8 

6 

Platform man,. ____, _ ... , .. .. 

9 

4 

5 

0 

0 

Helper, platform man .. . _ .. 

13 

10 

3 

0 

0 


Group 3—Pit workers 

Total_ _ 

125 

6 

22 

40 

57 

Helper, nozzle setter_ _ 

40 

1 

13 

0 

26 

Ladleman helper , ___ __ _ 

9 

0 

9 

0 

0 

Slagger_ 

0 

0 

0 

0 

0 

Pitman ,, _ . , _ ___ . . __ 

76 

5 

0 

40 

31 


Group 4—Tap, charge, and other workers 

Total_ _ 

89 

6 

7 

61 

15 

Observer_ 

16 

5 

4 

7 

0 

Stocker... ... _ _ _ ___ 

1 

1 

0 

0 

0 

Second helper_ ... 

57 

0 

3 

54 

0 

Turn foreman, electrical_ _ _ __ 

2 

0 

0 

0 

2 

Mold shed worker.__ .. .. ... _ _ 

13 

0 

0 

0 

13 


The responsibilities, operations, and working areas for the various 
occupations are briefly given in the discussion which follows: 

Ladle craneman .—This man operates the ladle crane for the lift¬ 
ing and moving of ladles, thimbles, pots, mud buckets, runners, stop¬ 
per rods, and supplies. During pouring he maneuvers the ladle 
into position over each mold. He also assists in pit clean-up opera¬ 
tions. He is responsible for inspecting his crane. 

Hot metal craneman .—This man operates an overhead crane on 
the charge floor for the addition of molten pig iron to the furnaces 
and other heavy lifting operations in handling materials of the charge 
floor. 

First ladle?nan .—He is responsible for the direction and supervision 
of the operations of a pit and pouring platform crew. The prepara¬ 
tion of ladles, thimbles, bottom pours, the pouring operations and pit 
clean-up all come within his province. The degree of responsibility 
will vary with the size of the plant. 

Steel pourer .—He assists the first ladleman in all pouring platform 


8 






























































operations and usually handles the stopper control during pouring. 
He will also do general work in the preparation of ladles and other 
pit operations. 

Platform man. — 1 he inspection of molds and bottom pour runners 
and the stocking of supplies for the pouring platform are duties of 
this man. During pouring he makes the mold additions of sodium 
fluoride or aluminum, takes test samples, uses the oxygen lance on 



Figure 1 .—Operating the stopper for a shut-off during pouring of rimmed 
steel. At right steel may be seen pouring from the ladle into the mold. 
At the left an industrial hygiene engineer is taking an air sample with 
the combined sampler described in the text. 


frozen nozzles, and splashes slag from the ingot. He will also do 
general pit work. 

Helper, platform man .—He assists the platform man in all opera¬ 
tions as directed. 

Helper , nozzle setter .—This man assists in the preparation of ladles; 
setting nozzles and stoppers, drying new linings and changing or 
moving flush pots. He helps the craneman in moving ladles, thimbles, 
and other items. He does general pit work and may help on the 
platform when necessary. 


9 





Ladleman helper .—The title is descriptive as his duties are to help 
in any way with the work of the first ladleman. 

Slagger .—This title is applied to unskilled laborers engaged in 
clean-up and maintenance operations in the pit. 

Pitman .—Engaged in general labor in the pit; this man is somewhat 
more experienced and skilled than the slagger. 

Observer .—Preliminary tests for manganese and carbon content of 
the steel are made by the observer. His responsibility is to observe 
and write up the detailed information on each heat produced. As 
much as 15 percent of his time may be spent in the pit, but mostly 
he is on the charge floor. 

Stocker .—Although his work is primarily to assist in the handling 
of materials in the stock house, this man may be called upon to work 
as a relief man in the open-hearth department. His exposure to pit 
fumes would be irregular, infrequent, and very difficult to determine 
or predict. 

Second helper .—This man is essentially a charge floor workman, 
however, certain of his duties take him into the pit from 1 to 2 hours 
per turn. It is his job to mud, prepare, and set the tapping runners. 
He also opens the tap hole and makes the addition of materials to the 
ladle during the tapping of his furnace. 

Turn foreman , electmcal .—He supervises electrical services and re¬ 
pairs in the open-hearth department. 

Mold shed worker .—This man assists in the preparation of molds 
for the casting of ingots. He does not work in the pit environment 
except as a substitute. 


INSTRUMENTS AND METHODS 


Air Sampling 

When this study was undertaken the question arose as to whether 
any fluorides in the atmosphere would be in the form of a dust, a gas, 
or a fume. The standard impinger, the electrostatic precipitator, and 
a combination filter and scrubber had variously been used by other 
workers in previous studies of the problem. 1 ’ 2 Therefore a prelimi¬ 
nary series of samples was taken at one of the plants to determine, if 
possible, the nature of the contaminants and the best means of collec¬ 
tion. The electrostatic precipitator was used at a sampling rate of 
3 cubic feet per minute. The standard impinger was used at the usual 
rate of flow, 1 cubic foot per minute. Solutions used in the impinger 
were 10 percent NaOH, 10 percent H 2 S0 4 and distilled water. As a 

1 Markuson, K. E.: The use of sodium fluoride in the manufacture of steel. Ind. Med., 
16 : 434, Sept. 1947. 

2 Unpublished data. 


10 



result of this work it was thought best to combine the two instruments 
for the collection of all air samples throughout the study. 

A special holder was constructed to use a portable extension head of 
the electrostatic precipitator in series with an all-glass standard im- 
pinger, in that respective order. The connection between the precipi¬ 
tator head and the impinger tube was made by means of short lengths 
of aluminum and rubber tubing. The fit was such as to give a mini¬ 
mum exposure of rubber to the gases being drawn through the setup. 
The exhaust tube of the impinger was connected by 8 to 10 feet of 
rubber tubing to a Wilson pump, which furnished the source of suction. 
All samples were taken at the rate of 1 cubic foot per minute. 

One hundred milliliters of 1 percent XaOH was used in the 
impinger. Phenolphthalein indicator was added to a few of the 
samples to demonstrate that the alkalinity of the solution was not 
being exhausted by any possible acid gases. 

The aluminum precipitator collection tubes, used for all samples, 
were coated with a thin film of lucite (methyl methacrylate) to pre¬ 
vent any possible reaction of the aluminum with fluorine compounds 
in the sample. Laboratory tests showed that this coating did not 
introduce any significant error into the subsequent analyses. 

The extension head allowed a moderate freedom of movement for 
15 to 20 feet, however, frequent movements of the pump and electro¬ 
static potential source were necessary to keep the sampling apparatus 
in the working area as the men moved along the extended pouring 
platform. The usual Wilson pump arrangement proved too clumsy 
to manage, therefore the motor and pump were mounted on a flat base 
with a sling handle so that a helper could move both pieces of equip¬ 
ment while the person taking the sample was allowed sufficient free¬ 
dom to keep up with the workers. Due to voltage variations on the 
platform and the bitter cold weather encountered, it was necessary to 
use a one-sixth horsepower high-torque motor with the Wilson pump. 
The usual one-tenth horsepower hi-speed motor was not equal to the 
job of turning the pump at the required speed. Electric power was 
supplied from 110-volt alternating current outlets along the platform. 
Several hundred feet of extension cord were used so that there would 
be no interruption of the sampling operation over the entire length 
of the pouring platform. Every effort was made to move with the 
workers and take the samples in their actual breathing zones. Each 
sample represents the complete pouring of a ladle of steel. 

In the crane cab the usual Wilson pump arrangement with a resistor 
was used on 250-volt direct current. The cabs were warm and the volt¬ 
age ample for the small motors. The 110-volt alternating current for 
the electrostatic precipitator was obtained either by means of an exten¬ 
sion cord from the platform or by the use of an inverter. These in¬ 
verters changed 250-volt direct current to 110-volt, 60-cycle, alternating 


11 


current. They did not have sufficient capacity to operate the motor 
and pump but were excellent for use with the electrostatic precipitator. 
Samples in the crane cab were taken in the operator’s breathing zone. 

General air samples in the pit and on the tapping platform were 
taken on stationary mounts at selected positions. The sampling 
holder was designed so that it could be attached to a tripod. 

Settled Dust 

Samples of settled dust were taken from overhead and protected sur¬ 
faces to eliminate, insofar as possible, general dirt. A steel spatula 
was used to remove the dust and place it in a sample envelope. 

Chemical Methods 

The fume and dust collected in the precipitator tubes was analyzed 
separately from the solutions contained in the impingers. The meth¬ 
ods used differed only in the preliminary treatment of the two types of 
samples. Details of the analytical methods are given in the following 
paragraphs. 

Determination of total fume .—The exterior surfaces of aluminum¬ 
collecting electrodes containing the fume samples were cleaned with 
redistilled 95 percent ethyl alcohol on a clean gauze pad, wiped dry with 
a second clean gauze pad and allowed to come to a state of equilibrium 
with the atmosphere for a period of 10 minutes (5 tubes were taken in 
each group). The tubes were then weighed directly on the pan of the 
Christian Becker, magnetically damped, analytical balance. The fume 
samples were then removed, with the use of either water or 30 percent 
alcohol and a rubber policeman, to platinum dishes. A wad of gauze 
was forced through the electrodes in order to remove all moisture, the 
outer surfaces were cleansed as previously and, after a 10-minute equi¬ 
librium period was again permitted to elapse, the tubes were reweighed, 
hhe differences in the electrode weighings, before and after sample 
removal, constituted the total fume weights. 

Determination of fluorine.—A. minimum of 2 milliliters of a 10 per¬ 
cent solution of Na 2 C0 3 was added to each sample. A greater volume 
of this reagent was desirable in the heaviest samples—up to 7 milliliters 
were added. The sample was evaporated to dryness on the steam bath, 
ashed at 550° C. in the muffle furnace for 2 hours (if manganese was to 
be determined on the residue, otherwise ashing was replaced by boiling 
with 0.5-1.0 milliliter saturated KMn0 4 solution) cooled and trans¬ 
ferred to the flask of the fluorine distillation apparatus with water and 
1 N NaOH (using a policeman). Fifteen milliliters of 60 percent per¬ 
chloric acid, reagent grade, were added, the temperature of the mixture 
was raised to 135-140° C. and the hydrofluosilicic acid was steam- 
distilled between 140-150° C, the distillate being received in a conical 


12 


beaker containing 5 milliliters of 1 X sodium hydroxide. About 150 
milliliters of distillate were collected, the alkalinity was checked and 
then it was diluted to 250 milliliters in a volumetric flask and a suitable 
aliquot taken for either the colorimetric zirconium alizarin procedure 
or the thorium nitrate titrimetrie method, depending upon the fluorine 
content of the sample. Generally, the titrimetrie method was applied 
to a 50/250 aliquot portion of each sample; if a low result was obtained, 
a separate aliquot was carried through the colorimetric procedure. 

Determination of manganese .—As noted above in the fluorine pro¬ 
cedure, all samples to be analyzed subsequently for manganese were 
ashed prior to the fluorine steam-distillation procedure. Upon com¬ 
pletion of this the still residue, containing metallic perchlorates, other 
salts and free perchloric acid, was transferred to 250-milliliter Phil¬ 
lips beakers followed by a thorough washing of the still with 10-15 
milliliters of concentrated hydrochloric acid. These washings were 
added to the main portion and the resulting solution evaporated to 
dryness. Ten milliliters of 18 X sulfuric acid and 5 milliliters of con¬ 
centrated nitric acid were added and the sample was evaporated to 
fumes of sulfur trioxide. The sample was then diluted with approxi¬ 
mately 5 milliliters of water, the sides of the beaker being rinsed down 
at this time, and evaporation to sulfur trioxide fumes effected again. 
To the resulting solution were added 3 milliliters of orthophosphoric 
acid and 30 milliliters of water and the sample was heated for a few 
minutes. It was then boiled gently with 0.3 gram of potassium peri¬ 
odate until the full permanganate color was developed. Upon being 
cooled to room temperature, it was transferred to a graduated cylinder, 
made up to a volume of 75 milliliters and compared with standards 
which had been carried through the same procedure. 

Determination of Iron .—If fluoride had also been determined on the 
precipitator samples, the residue was washed from the distilling flask 
with water and 1:1 hydrochloric acid. This solution was evaporated 
to 30-40 milliliters and adjusted with 20 percent XaOH and dilute 
HC1 until only slightly acid. After heating, the sample was poured 
rapidly with stirring into 50 milliliters of hot 10 percent XaOH. It 
was boiled gently for several minutes, and the precipitate was allowed 
to digest for a short while before cooling and filtering. The filter 
paper was wet with hot 5 percent XaOH containing a little Na 2 S0 4 
before filtering. The precipitate was washed thoroughly with hot 
water and the filtrate discarded. Ten to twenty milliliters of 6 X HCl 
was used to dissolve the precipitate into a 250-milliliter beaker. It 
was found necessary to put the paper in the beaker, add water and heat 
to obtain complete solution of the ferric hydroxide. The solution was 
refiltered to remove paper and insoluble material. Five milliliters of 
1:1 II,SO, was added and the sample evaporated to SO ;l fumes. 
Twice again the sample was taken to fumes of S0 3 after washing 


790731-48- 


3 


13 



down the walls of the beaker each time with a small quantity of water. 
On the third evaporation, it was allowed to fume strongly for several 
minutes, then cooled and diluted to 50 milliliters. This volume was 
passed through a Jones Reductor, followed by 75 milliliters of 5 per¬ 
cent H 2 S0 4 , and titrated with 0.01 N KMn0 4 . Orthophenanthroline 
indicator was used. 

On precipitator portions which were not analyzed for fluorine, the 
sample was washed into a platinum dish and evaporated to dryness. 
The residue was taken up in concentrated HC1 and diluted to 100 
milliliters. One-half of the sample was taken for the iron analysis. 
The aliquot was made just acid and treated by the same procedure as 
above. 

Impinger samples .—All impinger samples had been collected in 1 
percent sodium hydroxide. They were diluted to a volume of 200 or 
250 milliliters, mixed thoroughly, and split into two portions—one for 
the fluorine determination and the other for manganese analysis. 

The fluorine portion was transferred to a platinum dish and evapo¬ 
rated to dryness on the steam bath. It was then transferred to a 
fluorine still, 0.5 to 1.0 milliliter of a saturated solution of potassium 
permanganate was added and the mixture was boiled for 30 minutes in 
order to oxidize any organic material. After cooling, 15 milliliters 
of 60 percent perchloric acid were added and the hydrofluosilicic acid 
distilled as described under the fluorine procedure for precipitator 
samples. 

The manganese portion was transferred to a conical beaker and 
acidified with 18 N sulfuric acid. Ten milliliters excess of this acid 
and 5 milliliters of concentrated nitric acid were then added and the 
solution was evaporated to fumes of sulfur trioxide. It was then 
diluted with an equal volume of water (by washing down the sides of 
the beaker), 2 milliliters of 6 N hydrochloric acid were added and the 
sample evaporated to sulfur trioxide fumes again. Water was added 
once more and after fuming as above, the sample was heated with 3 
milliliters of orthophosphoric acid, 30 milliliters of water, and the 
permanganate color developed by boiling with potassium periodate 
as described under the manganese procedure for precipitator samples. 

Urine samples .—Although the results of the analyses of urine speci¬ 
mens for fluorine are not presented in the environmental section of this 
report, the analyses were made in the same laboratory as the others 
and it seems most appropriate to describe the chemical procedure with 
the other methods. 

Approximately 1 gram of calcium oxide and several milliliters of 
formalin were added to each urine specimen at the time of collection. 
The volume of each specimen was measured and the sample transferred 
to a platinum dish. After evaporating to dryness on a hot plate, the 
residue was ashed in a muffle furnace at 600° C. until a gray ash was 

14 


obtained. 1 his ash was transferred with a minmum amount of water 
to the distilling flask. Five grams of silver perchlorate monohydrate 
in aqueous solution was added to precipitate the chlorides. Then per¬ 
chloric acid was added and the distillation and determination carried 
out as previously described. The alkaline distillate was concentrated 
and a 50 percent aliquot used for the colorimetric determination. 


RESULTS OF THE STUDY 
Observations of the Environment 

The pit side of the open-hearth building is relatively open to air 
movement even during the winter months, as during this study. Door¬ 
ways for railway cars and trucks are always open at both ends of the 
building and at one or more places along the side. Sections of the 
sheet-metal siding may be removed for additional ventilation in hot 
weather. Some such sections are left off the year round. Air move¬ 
ment is relatively unrestricted. The heat from the furnaces and 
molten steel creates strong convection currents tending to carry fume 
and smoke out through the monitor roof. However, these currents 
are not entirely constant and are subject to considerable turbulence. 
Wind currents entering the several openings are likely to be much 
stronger than the convection currents resulting in rather unpredictable 
conditions of air movement. 

These variations of direction and rate of air motion greatly in¬ 
fluence localized concentrations of gases, smoke, and fumes during such 
operations as tapping and pouring. To such extent as was possible 
within the limited time spent at each plant, a variety of conditions 
was evaluated in all working areas. It is felt that the samples taken 
represent a reasonably accurate picture of conditions in each plant 
at the time of the study. No attempt is made to extrapolate exposures 
to other conditions of weather and season. 

Considerable variation of working temperatures is experienced by 
the workmen. Most of the excessive heat is produced by radiation 
from the molten steel rather than from actual air temperatures. Dur¬ 
ing tapping the workers on the tapping platform are subject to intense 
radiant heat as well as considerably elevated air temperatures. This 
is particularly true during the addition of coal to the molten steel in 
the ladle. These exposures are of relatively short duration. On the 
pouring platform, the workers are subjected to intense radiant heat 
from the tops of the recently cast ingots and the molten stream from 
the ladle. The platform man engaged in capping ingots must face 
and work in this area of great radiant energy. He must retreat at 
frequent intervals to a less exposed area for a brief respite. The crane- 


15 



Figure 2 .—Air sampling on the tapping platform above the ladle during 
the tapping of an open-hearth furnace. 

man, the steel pourer, and the platform man making the mold addi¬ 
tions are somewhat less exposed. When casting a double row of ingots 
all are uncomfortably exposed. 

Inasmuch as this study was made in a period of uncommonly cold 
weather, the temperature extremes were particularly emphasized. 
This was especially true during the pouring. A cold wind will strike 
. the men from one side while the other side is exposed to the radiation 
from the ingots and ladle. The men on the pouring platform are pro¬ 
tected to some extent by the wool coats and protective leggings which 
they are required to wear. Except for the man handling the stopper 
lever, they have a certain degree of freedom to move about in order to 
escape the heat and fumes at intervals. The men in the pit experience 
the same to a lesser degree, whereas thfc tapping platform is relatively 
comfortable except during the actual tapping of an adjacent furnace. 



Even then it is only necessary to move back far enough to be out of the 
line of the radiation. 

Eor certain grades of steel the molds are coated with tar or pitch 
to ensure a better ingot surface. Plants A and C use a coal tar and 
plants P and 1) use purchased refined pitch. The former are also 
the plants which use sodium fluoride additions to rimmed steels. At 
plant A molds are coated by filling them with the molten tar and 
allowing them to drain. At the other three plants the coating mate¬ 
rials are sprayed into the preheated molds. The spraying gives a rela¬ 
tively thin coating whereas at plant A many of the molds are apt to 
have a heavy coating and perhaps even a puddle of tar in the bottom 
of the mold. When molten steel pours into the molds the coating mate¬ 
rials burn rather vigorously. With excessive amounts of tar in the 
mold the resulting flames may envelop the base of the ladle, perhaps 
enter the crane cab, and menace the workers on the platform. Con¬ 
siderable smoke and irritating fume are also evolved. 

Qualitative tests of the tar smoke showed the presence of consid¬ 
erable amounts of acridine. Acridine is highly irritating to the 
mucosa. The smoke may also be presumed to contain anthracene and 
other such coal tar constituents. At plant A the mold yard is so 
located as to permit relatively concentrated clouds of the tar smoke 
to be blown into the pit-side working area. The workers complained 
considerably of this undesirable situation. 

Ferromanganese, coal, sulfur, sodium fluoride, aluminum, etc., may 
be added to the steel in the ladle. The ferromanganese and aluminum 
produce no appreciable or obnoxious fume. Coal in 50-pound bags 
is thrown into the ladle. It burns intensely, producing large quant ities 
of heat, smoke, and cinders which are thrown olf into the surrounding 
working areas. Sulfur may be added in bags or shoveled in. Sulfur 
dioxide is evolved with the resulting characteristic irritating effects 
on all workers in the surrounding area. These sulfur heats are few 
in number and during this study only one sulfur heat was encountered. 

Sodium fluoride is used in paper bags holding approximately 50 
pounds each. Heretofore, the bags were filled by hand: however, this 
practice is being eliminated by purchasing the sodium fluoride already 
packaged in sealed bags. The required number of bags of sodium 
fluoride, usually two, are thrown into the ladle during tapping. Any 
resulting fume is not readily discernible from the other fume accom¬ 
panying the tapping. 

Sodium fluoride and aluminum may also be added to the steel in 
the molds to produce the proper rimming action. Aluminum shot is 
thrown in to kill excess action. Sodium fluoride in double, sealed, 4- 
ounce cellophane bags is added to increase the rimming action. The 
amount of either to be added to each mold is determined by the man 


17 


teeming the pour, and is dependent in part upon the carbon content a nd 
type of steel. The additions are made by throwing the materials into 
the molds as the steel is poured. At plant A two bags (8 ounces) are 
added to each mold of practically all of the rim heats, whereas at 
plant C from 15 to 20 bags (60 to 80 ounces) are added to each mold 
of many heats; smaller quantities being used on some heats. 

The crane cabs are provided with electrical heaters which keep the 
interiors at a reasonably comfortable temperature even in the very cold 
weather. Pedestal fans are provided in most crane cabs to provide 
additional ventilation in the summer and to keep smoke and fume out 
by directing the air stream out the open window. The operators keep 
both windows open most of the time. Sometimes one window will be 
closed completely and the other partially during pouring operations. 
In general, the windows are too dirty to provide proper vision when 
closed. At plant C the ladle cranes each have a large fan mounted on 
the outside of the cab. These fans are so directed as to send an air 
stream away from the platform and between the molds and the cab 
window in an attempt to keep the fume and smoke from entering the 
cab. 

The crane operators are subjected to some radiant heat but seldom 
for extended periods and usually of less intensity than on the plat¬ 
forms. While picking up a ladle of hot metal some radiant heat is 
received. During the pouring of molds in a single row, the crane 
operator is protected by the ladle between him and the hot ingots. 
In casting double lines of molds and occasionally in other activities 
the crane cab will be directly over hot or live ingots. Appreciable 
radiation can be received at such times. However, it is usually possible 
for the operator to shift his position so as to avoid the worst of these 
exposures. Past experience has proven it necessary to insulate the 
bottom of the cabs to prevent the metal floor plates from becoming too 
hot to stand on. 

The men in the pit proper are the least subjected to smoke and 
fume from tapping and pouring operations. The convection cur¬ 
rents tend to carry these upward away from the pit workers. They 
are exposed to a fair amount of radiant heat from hot molds, slag 
spills, etc. Usually excessively uncomfortable exposures are of brief 
duration or can be avoided by moving out of the immediate area. 

The pit workers are exposed to high dust concentrations during 
the cleansing of slag from beneath the furnaces and spills from the 
pit floor. This dust is mostly slag, steel, and common dirt. There 
is no reason to suspect undue amounts of silica. Nevertheless the 
pit workers receive some exposure to silica during the relining of 
ladles and the rebuilding of furnaces. The environmental phase of 
this study did not concern itself with possible free silica exposures. 


18 


Nature and Concentration of Air Contaminants 

Settled-dust samples from the pouring platform, the tapping plat¬ 
form, and the crane cab were examined by X-ray diffraction. Mag¬ 
netite, ferric oxide, and graphite were the principal constituents of 
the dusts. Quartz appeared in trace quantities in all of the samples. 
Only one of the samples showed amounts of sodium fluoride detect¬ 
able by this method. 

The dust and fume from an electrostatic precipitator sample taken 
over the mold while sodium fluoride was being added to the ingot 
showed a definite, strong X-ray diffraction pattern for sodium flu¬ 
oride as such. The chemical analyses of the impinger portions of a 
number of air samples revealed relatively little fluorine in these solu¬ 
tions. The findings from these two approaches indicate that there 
was little, if any, formation of fluorine or hydrogen fluoride. It is 
probable that the fluoride contamination of the atmosphere is in the 
original form of sodium fluoride. 

Iron and manganese were determined on a number of atmospheric 
dust and fume samples selected from all sampling locations and con¬ 
ditions at each of the four plants. The iron, expressed as ferric oxide, 
was found to range from 0.1 to 8.9 milligrams of ferric oxide per cubic 
meter of air. The manganese concentrations were very low with a 
maximum of 1.3 milligrams of manganese per cubic meter of air. 
In many of the samples manganese was not detectable by the method 
used. Even the maximum concentrations of iron and manganese 
found in these plants are well below the values at which any signifi¬ 
cant health impairment from these materials might be expected among 
the workers exposed. 

The determination of iron and manganese served the very useful 
purpose of demonstrating that conditions in the several plants were 
comparable in respect to the concentrations of these substances in 
the air. There were no significant, distinguishable differences among 
the four plants upon the basis of these results. Iron forms approxi¬ 
mately 99 percent of steel by weight and the percentages of man¬ 
ganese in the steels poured during this study did not vary greatly. 
These facts support the validity of using plants B and 1), where 
sodium fluoride was not used, as controls for comparison with the 
other two plants in the evaluation of the possible health hazard from 
the fluoride exposures. 

Table 3 offers in a brief form the results of the determinations of 
sodium fluoride concentrations in the pit-side atmosphere. In the 
upper portion of the table, concentrations found during the pouring of 
fluoride heats are grouped according to the working area in which 
the samples were taken. The values for the pouring platform include 
workers’ exposures during pouring for all of the platform jobs. These 


19 


were all within the same range; therefore, they are grouped to¬ 
gether. The general air samples were taken in the pit, on the tapping 
platform, on t lie crane escape platform, and in the cab of a crane 
not pouring at the time. These samples were collected while the 
pouring of fluoride heats was in progress but not in the imme¬ 
diate vicinity of the pouring. Those on the tapping platform were 
located directly across tlie pit from the pouring operation. I he 
designation “tapping” refers to workers’ exposures taken on the tap¬ 
ping.platform during the tapping of a heat to which sodium fluoride 
was added in the ladle. 

The lower portion of table 3 gives values for sodium fluoride con¬ 
centrations during the pouring of heats to which no sodium fluoride 
was added in either the ladle or the molds. The first grouping is a 
composite of all such samples taken in the fluoride-using plants. This 
group includes both workers' exposures and general air. The values 
are all so very low as to have no significant difference with respect to 
exposure; therefore, they are presented as a single group representing 
the nonfluoride heat operations. The second grouping in this portion 
of the table shows the results of analyses for sodium fluoride in the 
air of the control plants, where the compound was not used. As might 
be assumed, no sodium fluoride was found. 


Table 3 .—Concentrations of sodium fluoride in the air in various working 
areas in the open-hearth department of 4 steel plants 

[Concentrations expressed as milligrams sodium fluoride per cubic meter of air] 


Working area 

Number 
of samples 

Concentrations 

Approxi¬ 
mate du¬ 
ration of 
exposure, 
hours per 
day 

Weighted 

daily 

exposure 

Mini¬ 

mum 

Maxi¬ 

mum 

Median 


Heats using sodium fluoride 

Ladle crane_ 

13 

1.0 

51.2 

8.8 

2 

2.2 

Pouring platform_ 

29 


2 

21. 9 

1.6 

2 

.4 

General air__ _ 

i 13 

( 2 ) 


14.0 

( 2 ) 

6-8 

( 2 ) 

Tapping.. . ... _... _ .. 

3 4 

( 2 ) 


40.1 

1.0 

H 

(2) 


Heats not using sodium fluoride 

Composite of all areas in fluoride-using 

4 21 

( 2 ) . 


0.3 

( 2 ) 


( 2 ) 

plants_ 








Composite of all areas in nonfluoride- 








using plants__ _____ 

10 

( 2 ) 


( 2 ) 

( 2 ) 


( 2 ) 







1 Of these 13 samples, 8 showed negligible amounts of sodium fluoride and the remaining 5 showed values 
as follows: 0.2, 0.3, 0.4, 0.6, and 14.0. 

2 Negligible. 

3 These 4 samples had the following values: Negligible, 1.0,1.1,40.1. 

4 The only 3 positive samples in this group had values of 0.2, 0.3, and 0.3, respectively. 

Because of the undue influence of a few very high values upon the 
arithmetical mean of such a limited number of samples, the mean 
is of dubious significance. It is felt that the median is a more repre- 


20 


































sentative and valuable figure, hence it has been used in presenting the 
results and subsequent calculations. All values have been rounded off 
to the nearest tenth of a milligram and those below 0.05 milligram are 
indicated as negligible. 

Iotal fume concentrations were determined upon the electrostatic 
precipitator portions of all atmospheric samples. This includes all 
particulate matter capable of collection under the conditions of sam¬ 
pling. I sing the same grouping as to working area as in table 3, 
we have shown in table 4 the total fume concentrations found. The 
results for plants A and C were combined, as were those for plants B 
and I). The ranges were sufficiently close to recommend this ap¬ 
proach. I nder each working area there are three subdivisions. The 
samples taken during the tapping or pouring of fluoride heats have 
been separated from those representing activities in which sodium 
fluoride was not used, and the two sets of data shown separately. The 
third subdivision under each working area is the composite of all such 
samples from the control plants, which do not use sodium fluoride. 


Table 4.— Total jurne concentrations by working areas in the open-hearth 

department oj 4 steel plants 


[Concentrations expressed as milligrams total fume per cubic meter of air] 




Num¬ 

Concentration 

Working area 

Condition 

ber of 
samples 

Mini¬ 

mum 

Maxi¬ 

mum 

Median 

Ladle crane 

Fluoride heats_ 

13 

2.8 

73.4 

14.8 


Nonfluoride heats_ _ 

4 

1.7 

9.2 

2.3 


Control plants_ 

10 

2.2 

17.9 

4.0 

Pouring platform. .... 

Fluoride heats_ 

29 

.9 

35.2 

7.4 


Nonfluoride heats.. 

3 

2.4 

3.1 

3.0 


Control plants.... 

16 

1.6 

10.7 

3.4 

General air_ 

Fluoride heats .. 

‘ 13 

.9 

34.8 

4.4 


Non fluoride heats.. ... __ 

2 13 

1.1 

10.5 

2.1 


Control plants_ 

19 

.3 

24.8 

4.0 

Tapping 

Fluoride addition . 

33 

2.2 

31.8 

6.8 


No fluoride addition_ 

2 

3.5 

7.8 

(5-6) 


Control plants....... 

2 

2.1 

5.7 

(3.9) 


' Three high values of this series were 34.8,14.6, and 7.7. 

2 Three high values of this series were 10.5, 8.2, and 6.6. 

3 All 3 samples are shown. A fourth sample (595.0 mg./mS) was discarded because of being so excessively 
out of line. It contained considerable coal dust and cinders of a large-particle size. 


Of interest to note is the ratio of iron, as ferric oxide, to total fume. 
In all plants the ferric oxide was roughly 20-35 percent of the total 
fume. Although the relationship varied considerably, the majority 
of values fell into or near this range. At the control plants, the values 
tended to be somewhat higher. It is presumed that that portion of the 
total fume which is not accounted for as ferric oxide and sodium 
fluoride is tar smoke and general dust from the pit. 

Previous mention has been made of the strong positive test for 
acridine in the tar smoke from the mold coating. 


21 


790731 — 48 - 4 




























Interpretation of Occupational Exposures 

Concentrations of iron in the air, whether expressed as the element 
or one of the oxides, were not high enough to be considered as an 
important exposure with respect to possible health hazards. The same 
was true of manganese. For all plants the greatest iron concentra¬ 
tion, expressed as ferric oxide, was 8.9 milligrams per cubic meter of 
air as compared with the generally accepted maximum allowable con¬ 
centration of 15 milligrams of iron oxide fume per cubic meter of air. 3 
Similarly for manganese the maximum concentration found was 1.3 
milligrams of manganese per cubic meter in comparison with the 
usual limit of 6.0 milligrams. 3 

On the basis of an 8-hour workday, weighted exposures to sodium 
fluoride were calculated from the median values of the samples and 
from an estimate of the average hours per day spent in each exposure 
area. 

For each occupation the weighted exposures were as follows: 


OCCUPATION 

Ladle craneman_ 

Hot metal craneman_ 

First ladleman_ 

Steel pourer_ 

Platform man_ 

Platform man helper_ 

Nozzle setter helper_ 

Ladleman helper_ 

Slagger - 

Pitman_ 

Observer_ 

Stocker_ 

Second helper_ 

Turn foreman, electrical 

Mold shed worker_ 

1 Negligible. 


Milligrams of sodium fluoride 
per cubic meter of air 

_ 2.2 

_ C) 

_ .4 

_ .4 

_ .4 

_ .4 

_ C) 

- C) 

- C) 

- o 

- o 

- n 

_ o 

- o 

-- o 


The above figures thus obtained are indicative of the probable and 
comparative exposures of these occupations. The calculation of such 
exposure data is made extremely difficult by the intermittent and ir¬ 
regular schedule of operations. The number of heats poured in a 
shift by one platform crew may vary from none to five. Certain 
men work mostly in the pit and are on the pouring platform only 
when heats tap too close together for the regular pouring crew to 
handle them. It was possible to secure the total number of heats and 
the proportion of fluoride heats poured during the preceding year. 
From these data and the observed length of the operations an average 

3 1947 M. A. C. Values (accepted by the American Conference of Governmental Industrial 
Hygienists) Industrial Hygiene Newsletter, August 1947. 


22 


















was obtained for tlie time spent in pouring fluoride and nonfluoride 
heats by a crew in a turn. Ihe task was made somewhat easier by the 
fact that all exposures on the pouring platform could be grouped 
together and that the exposures, other than during a fluoride pour, 
were generally negligible regardless of working area. Because of the 
relatively low value all pouring platform workers were given the 
same exposure value on the basis that none would vary significantly 
from this value. The crane operator’s exposure was perhaps the 
easiest to estimate Because he works his full turn in a definite area. 

Ihe weighted exposures are somewhat low’ with respect to pre¬ 
vious thinking on the matter of threshold and permissible concentra¬ 
tions for sodium fluoride exposures. The actual exposures in the 
crane cab and on the pouring platform consist of several periods 
daily of 30 minutes to 1 hour in concentrations varying from low T 
to quite high. 

A further examination of table 4 will show’ that total fume con¬ 
centrations are somewhat higher during the pouring of fluoride heats. 
An attempt to derive weighted exposure data in the same manner 
as w r as done with the sodium fluoride concentrations revealed no sig¬ 
nificant difference for the various occupations. Here also the ex¬ 
posure is a combination of high and low concentrations of varying 
duration. The weighted exposures range from 3 to 7 milligrams of 
total fume per cubic meter of air in plants A and C. The exposures 
at plants B and I) tend somewdiat toward the low er end of the range. 
At plant D the men complained of the smoke and fume from the 
electric furnaces located in the same building. Sampling w’as con¬ 
fined to the open-hearth areas and concentrations found w’ere slightly, 
though hardly significantly, low’er than in plant B. Any additional 
irritating effects attributable to the electric furnace fume would seem 
to be due to its chemical composition or to possibly more intense 
exposures in that department. 


SUMMARY OF ENVIRONMENTAL FINDINGS 

This report of the working environment on the pit side of open- 
hearth departments is based on conditions as found in four steel 
plants. Two of these plants used sodium fluoride and two did not. 
The study was made under winter weather conditions only. In¬ 
cluded is an occupational analysis of the workers who were given 
physical examinations. This group included pit-side w’orkers at the 
four plants and certain other selected groups. 

Determination of iron oxide and manganese concentrations for the 
various locations and operations revealed that the maximum values 
were well below’ any which would be considered as dangerous to the 


23 


health of the employees. The uniformity of these results for all 
plants is noted as an index to the similarity of general, over-all con¬ 
ditions between those plants using sodium fluoride and those not 
using it. 

The results of 90 determinations of sodium fluoride in the air are 
reported and the data are used to obtain a weighted exposure for 
the various occupations. The maximum and minimum exposure are 
widely spread for a given working area and the median is believed 
to be a more reliable index than the arithmetical mean. Concentra¬ 
tions of sodium fluoride are generally negligible except during and 
in the close vicinity of its use. The ladle crane operators receive the 
greatest exposures. The pouring platform workers receive a lesser 
exposure and other occupational exposures are negligible. Weighted 
exposures for the crane operators and pouring platform men are 2.2 
and 0.4 milligrams of sodium fluoride per cubic meter of air, respec¬ 
tively. Exposures actually are intermittent and of moderate dura¬ 
tion and cover a wide range of concentrations. Chemical and X-ray 
diffraction examinations of fume samples indicate that the sodium 
fluoride appears in the air unchanged. 

Total fume concentrations are given. There is indication of greater 
total fume exposures with the use of sodium fluoride; however, 
weighted exposures for all occupations at the four plants fall into an 
approximate range of 3 to 7 milligrams of total fume per cubic meter 
of air. 

Acridine is identified as a constituent of the smoke from the tar 
used for mold coating at plants A and C. At plant A the irritation 
from the tar smoke was particularly severe. 

The discomfort arising from exposure to heat radiating from the 
molten steel and hot ingots is noted. 

Results of the air samples show that the ladle-crane operators have 
the greatest exposure to sodium fluoride and total fume. They are 
also subject to heat, smoke, and occasionally even flames entering the 
cab windows during steel-pouring operations. The crane-cab win¬ 
dows are frequently, even usually, open during such operations. 


CONCLUSIONS FROM ENVIRONMENTAL FINDINGS 

1. Concentrations of iron oxides and manganese fumes were below 
the accepted maximum allowable concentrations and it is concluded 
that they would not constitute a significant health hazard. 

2. When sodium fluoride was added to the molten steel in the molds 
or ladles, the compound was dispersed, without chemical change, into 
the working atmosphere. The weighted exposures of the workmen 


24 


were not great enough, in the light of present information, to indicate 
any probable hazard of chronic toxic effects. 

3. Acridine and other irritating factors in the smoke from mold 
coatings, during coating and pouring operations, were very irritating 
to the sensitive tissue of tlie nose and throat. 

4. Discomfort caused by radiant heat was excessive. 


RECOMMENDATIONS FROM ENVIRONMENTAL 
FINDINGS 

The following five recommendations are offered for the control or 
elimination of certain exposures noted in the environmental section 
of this report. 

1. Mold-coating operations should be controlled to avoid unneces¬ 
sarily thick coatings which result in considerable discomfort to work¬ 
men while pouring steel. The use of a dry spray of the coating 
material and proper preheating of the molds have proven effective at 
the plants using this method. 

2. Substitution of a mold-coating material giving less dense and 
less irritating smoke and fume than the present coatings should be 
sought in order to eliminate the general discomfort and irritating 
effects to the cranemen and pouring crews. Research would be neces¬ 
sary to find such a material which would be also technically acceptable. 

3. Wherever possible intense exposures to radiant heat should be 
reduced or eliminated by use of protective clothing, remote controls, 
or other means. On the tapping platform ladle additions should be 
made by remote-controlled, mechanical hoppers. Any device or 
change in procedure which will bring greater distance between the 
workman and the source of radiation would reduce the discomfort of 
the exposure. 

4. The possibility of eliminating dust, fume, smoke, and heat expo¬ 
sures of cranemen by the use of a positive-pressure ventilating system 
with filtering of intake air should be explored. 

5. Crane-cab windows should be cleaned regularly and frequently 
to permit proper vision when closed. This would encourage the oper¬ 
ators to keep these windows closed during peak exposures to dusts, 
fumes, smoke, flame, and heat. These exposures could thus be mate¬ 
rially reduced. 


25 


Characteristics of the 
Group Studied 


AGE DISTRIBUTION OF WORKERS EXAMINED 

As may be observed from table 5 the percentage age distribution 
of workers in the four plants studied shows a trend toward two dis¬ 
tinct frequency curves reaching a peak at age 30 to 34 years and 
again at age 50 to 54 years. This appears unusual and suggests 
that two separate population groups may be involved. A fluoride¬ 
using plant and a plant that does not use fluoride show this peculiarity. 


Table 5 .—Age distribution oj male workers in the open-hearth department 

oj 4 steel plants 


Age (years) 

All 

plants 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 


Number 

Total.___-. 

350 

48 

63 

139 

100 

Under 25_ 

20 

0 

1 

11 

8 

25 to 29___ 

34 

3 

5 

21 

5 

30 to 34_ 

55 

6 

11 

28 

10 

35 to 39....__ 

44 

5 

7 

25 

7 

40 to 44___ 

37 

14 

5 

7 

11 

45 to 49_ 

46 

12 

11 

8 

15 

50 to 54_ 

55 

3 

15 

17 

20 

55 to 59_ 

36 

3 

4 

14 

15 

60 to 64_ 

13 

1 

3 

4 

5 

65 or over--- 

10 

1 

1 

4 

4 


Percent 

Total...... 

100.0 

100.0 

100.0 

100.0 

100.0 

Under 25.----- 

5.7 

0 

1.6 

7.9 

8.0 

25 to 29___ 

9.7 

6.2 

7.9 

15.1 

5.0 

30 to 34_ 

15.7 

12.5 

17.5 

20.1 

10.0 

35 to 39...... 

12.6 

10.4 

11.1 

18.0 

7.0 

40 to 44__ 

10.6 

29.2 

7.9 

5.0 

11.0 

45 to 49_ 

13.1 

25.0 

17.5 

5.8 

15.0 

50 to 54___ 

15.7 

6.3 

23.8 

12.2 

20.0 

55 to 59_______ 

10.3 

6.2 

6.3 

10.1 

15.0 

60 to 64____ 

3.7 

2.1 

4.8 

2.9 

5.0 

65 or over-- 

2.9 

2.1 

1.6 

2.9 

4.0 

Median age............ 

43.0 

43.6 

46.1 

36.9 

48.0 


1 Public Health Bulletin No. 262. 


26 

















































A very much larger percentage of older workers were found in 
this study. For example, the percentage of males 50 years of age 
or over in certain industries is as follows: Open-hearth steel indus¬ 
try 32.6 (see table 5), storage battery industry 1 18.1, Utah coal 
mines 2 13.2, cemented tungsten carbide industry 3 12.4, Utah metal 
mines 4 12.0, shipyards 5 11.1, asbestos industry 6 5.4, and trucking in¬ 
dustry 7 1.2. The median age of open-hearth workers was 43 years. 
In none of the other industries cited above was a median age of 40 
years reached and in 5 out of 7 industries the median was less than 
35 years of age. The median age among males for plants in this 
study was 36.9, 43.6, 46.1, and 48.0 years. 


BIRTHPLACE 

Although open-hearth steelworkers remain for long periods within 
that same industry, there is considerable migration from one steel 
plant to another steel plant. This is evidenced by the fact that only 
35.4 percent of these workers were residing in the State in which they 
were born at the time they were interviewed. Similar data for 
cemented tungsten carbide workers showed 67.2 percent working in 
the State where they were born. Even shipyard workers, who were 
considered a group with a high migration rate, had 38.7 percent work¬ 
ing in the State where they were born. The percentages by individual 
open-hearth steel plants were as follows: 43.9, 37.5, 31.0, and 22.2. 

The percentage of open-hearth workers born in the same or an 
adjacent State was 56.3 compared with 56.1 percent among shipyard 
workers. The percentages for the four open-hearth steel plants were 
42.0,44.4,64.0, and 79.2. The chief reason for these considerable inter¬ 
plant differences appears to be the relative distance of a plant from 
the State boundary. 

A third of all the workers examined in these plants were born in 
countries other than the United States. The percentage of foreign 
born among shipyard workers and cemented tungsten carbide workers 
was 4.7 percent and 11.9 percent, respectively. The two plants cur¬ 
rently using sodium fluoride showed 16.7 and 30.2 percent of the 
workers to be foreign-born, while corresponding percentages for non¬ 
fluoride-using plants were 34.9 and 41.0. 

Of the total foreign-born persons in the four plants seven-tenths 
were born in eastern Europe or Asia Minor, including Czechoslovakia, 


1 Public Health Bulletin No. 262. 

3 Public Health Bulletin No. 270. 

3 Unpublished data. 

* Public Health Bulletin No. 277. 

8 Public Health Bulletin No. 298. 

* Public Health Bulletin No. 241. 

i Public Health Bulletin No. 265. 


27 



Yugoslavia, Hungary, Poland, Rumania, Serbia, Russia, Greece, and 
Turkey. Only 8 persons were born in the British Isles, 1 person each 
in Germany and Belgium, 14 persons in Italy, and 7 in Spain. One 
worker was born in Canada and none was born in Central or South 
America. 


MARITAL STATUS 

There was no large group of single men among these open-hearth 
steelworkers. Even among men under 30 years of age 57.4 percent 
were married. More than four-fifths of the men were married in each 
age group beginning with 30 to 34 years. The largest percentage mar¬ 
ried, 90.9, was in the age group 50 to 54 years. After this age the per¬ 
centage married decreased because of an increase in the percentage of 
widowed, which reached a maximum of 8.7 percent among those 00 
years of age or over. All of the widowed fell into the age groups 35 
years of age or over. Those divorced were in the middle age groups, 
from 30 to 49 years. 

Among open-hearth steelworkers the percentages married, single, 
or widowed or divorced were, respectively, 82.5, 12.6, and 4.9. Corre¬ 
sponding percentages for shipyard workers were 79.3, 16.3, and 4.4. 
Differences between the two groups are slight and due probably to the 
older age of the open-hearth steelworkers which tends to decrease the 
percentage single and increase the percentage widowed or divorced. 


PERSONAL HABITS 


Alcohol 

The percentage of male open-hearth steelworkers who said they did 
not use alcohol was just one-half as great as among male shipyard 
workers; namely, 19.4 and 38.8 percent, respectively. However, in 
shipyards located in the North the percentage who did not use alcohol 
fell almost to the rate for open-hearth steelworkers, indicating that 
the difference may be principally related to regional factors. Among 
open-hearth steelworkers 30.7 percent said they used beer and wine 
only, 9.9 percent said they used liquor only, and 40.0 percent used all 
three types. Of those admitting to the use of alcohol in some form the 
percentage using all three types was almost the same for open-hearth 
steelworkers and shipyard workers. 

The percentage of men who said they did not take alcohol in any 
form varied by plant as follows: 12.5,15.9, 22.9, and 29.6. The higher 
percentages of total abstainers were in the two plants located in smaller 


28 


towns. In the two larger urban areas a greater percentage of the 
workers drank alcohol and a greater percentage drank all three types. 

No age trends could be observed from table 6 in the percentage of 
persons taking alcohol. 


Table 6. Percentage oj male workers in the open-hearth department oj 4 
steel plants with certain habits, according to age 


Habits 


Use of tobacco: 

None - ...._ 

Smoking, with or without chewing. 

Chewing only . ___ 

Use of alcohol: 

None ___ 

Beer and wine only_ 

Liquor ___ 

Hours of sleep: 

6 or less ____ 

7 and 8 ____ 

9 or over___ 

Baths taken per week: 

Daily___ 

6 to 3__ 

2 or less___ 


Age (years) 


Totnl 

Under 30 

30 to 39 

40 to 49 

50 to 59 

60orover 

17.2 

16.7 

12.6 

16.0 

20.9 

26.1 

77.9 

79.6 

83.2 

77.8 

75.8 

60.9 

4.9 

3.7 

4.2 

6.2 

3.3 

13.0 

19.4 

18.5 

15.6 

25.9 

17.6 

21.8 

30.7 

40.7 

19.8 

38.3 

29.7 

30.4 

49.9 

40.8 

64.6 

35.8 

52. 7 

47.8 

12.9 

7.5 

11.6 

9.9 

18.0 

21 7 

64.8 

60.4 

66.3 

7a 5 

58.4 

52 2 

22.3 

32. 1 

22.1 

13.6 

23.6 

26.1 

26.5 

38.9 

36.5 

22.5 

16.7 

8.7 

49.6 

51.8 

58.3 

52.5 

38.9 

39.1 

23.9 

9.3 

5.2 

25.0 

44.4 

52.2 


Tobacco 

The use of tobacco was reported by 82.8 percent of the male open- 
hearth workers and 82.3 percent of the male shipyard workers. This 
remarkably close agreement in the use of tobacco compared with the 
difference in the use of alcohol suggests possible difficulties in elicit 
ing a truthful response with respect to the latter habit. In most in¬ 
stances smoking, either alone or in combination with other forms of 
tobacco, was the type of use specified, (diewing tobacco or snuff only 
was reported by 4.9 percent of all workers. This was not evenly 
distributed because in one plant there was no report of this prac¬ 
tice, and in the other three plants 4.1 percent, 5.2 percent, and 12.5 
percent chewed or took snuff only. 

According to age the percentage of open-hearth workers using to¬ 
bacco was as follows: Less than 40 years 86.3 percent, 40 to 49 years 
84.0 percent, 50 to 59 years 79.1 percent, and 60 years or over 73.9 
percent. (See table 6.) As might be expected, persons who chewed 
or took snuff only were for the most part middle-aged or older. 


Sleep 

The percentage distribution of hours of sleep as reported by open- 
hearth workers was as follows: 5 hours or less 3.2 percent, 6 hours 
9.7 percent, 7 hours 20.8 percent, 8 hours 44.0 percent, 9 hours 11.2 


790731—48 - 5 


29 

























percent, and 10 hours or ]onger 11.1 percent. Compared with other 
groups for whom such information is available these workers slept 
longer than either shipyard workers or cemented tungsten carbide 
workers. For example, 22.3 percent of them slept 9 hours or longer 
while the other two groups showed 12.6 percent and 7.9 percent, 
respectively. They show almost identical percentages with ship¬ 
yard workers when 8 hours and 5 hours or less of sleep are considered. 

Certain trends with respect to age and hours of sleep were observed 
in table 6. The percentage of open-hearth steelworkers with 6 hours 
or less sleep was 7.5 under 30 years of age, 11.6 30 to 39 years, 9.9 40 
to 49 years, 18.0 50 to 59 years, and 21:7 for 60 years or over. On the 
other hand, the percentage with 9 hours or longer sleep for the cor¬ 
responding ages was 32.1, 22.1, 13.6, 23.6, and 26.1, respectively. 
From these data it would appear that the proportion of persons with 
a minimum amount of sleep tends to increase after 50 years of age, 
but the proportion of persons with the greatest amount of sleep ap¬ 
pears high both in youth and old age. Plant differences in amount 
of sleep are considerable. The two plants in large cities showed a 
smaller proportion of men with 6 hours or less sleep and a higher 
proportion with 9 hours or more sleep than did the two plants located 
in the smaller cities. Possibly this may be related to the time con¬ 
sumed in going to and from work and tasks performed at home. 
Persons spending less time in travel would have more time for sleep. 

Baths 

Work in steel mills is extremely dirty so that frequent baths might 
be considered necessary. On the other hand, the present study was 
conducted during the middle of the winter at a time when the tem¬ 
perature was often below zero. Frequent bathing in such severe 
winter weather is unlikely. Daily baths were reported by 26.5 per¬ 
cent of the open-hearth steelworkers as compared with 23.8 percent 
of the cemented tungsten carbide workers and 47.0 percent of the 
shipyard workers. Almost half of the second group were examined 
during the summer and nearly all of the last group were examined 
when the temperature was above freezing. Taking the above facts 
into consideration, it would appear that open-hearth steelworkers 
made a relatively favorable showing with regard to daily baths. 
More, than four baths per week were taken by 52.8 percent of these 
workers and by 34.8 percent of the cemented tungsten carbide work¬ 
ers. For the same industrial groups the percentage with two baths 
or less per week was 23.9 and 27.4. 

There appears to be a definite inverse relationship between frequency 
of bathing and age as shown by table 6. The following percentage 
taking daily baths was observed: Under 30 years of age 38.9, 30 to 39 


30 


years of age 36.5, 40 to 49 years of age *22.5, 50 to 59 years of age 16.7, 
ami 60 years of age or older 8.7. On the other hand, the percentage 
taking two baths or less per week in these age groups was as follows: 
9.3, 5.2, 25.0, 44.4, and 52.2. In both series the trend toward less 
frequent baths with older age is noticeable. 


WORK EXPERIENCE 

Previous Occupational History 

Because of a long history of employment in the steel industry the 
average worker examined in this study had other work experience of 
relatively short duration. No previous experience other than agri¬ 
culture, forestry, or fishing was reported by 20.6 percent of the open- 
hearth workers, compared with 15.2 percent of the cemented tungsten 
carbide workers and 16.9 percent of the shipyard workers. Trade or 
service, with or without agricultural experience, was reported for 30.9 
percent of the open-hearth workers. Dusty trades accounted for the 
past experience of 19.8 percent of the males examined. This was com¬ 
posed of mining and quarrying 9.4 percent, foundry work 5.2 percent, 
and other dusty trades including glass manufacture, brick making, 
and pottery making 5.2 percent. 

The highest and lowest percentage of persons with previous experi¬ 
ence in dusty trades, 31.3 percent and 13.0 percent, were found in the 
plants using sodium fluoride. No great interplant differences were 
observed (see appendix, table A) in the percentage of persons with no 
occupation other than agricultural work. 

Experience in the Steel Industry 

Early entrance and long-continued work within the industry is 
the characteristic pattern observed among open-hearth steelworkers. 
The men in these plants are no exception. Table 7 shows that 3.7 
percent of the men examined had worked in the steel industry 40 years 
or over, 17.4 percent 30 years or over, 39.1 percent 20 years or over, and 
64.8 percent 10 years or over. Mining is also an industry where 
employment is likely to be long continued, but Utah coal miners and 
Utah metal miners showed only 23.5 percent and 14.4 percent, respec¬ 
tively, who had worked 20 years or over, which is a considerably 
smaller proportion for this duration than found among open-hearth 
steelworkers. The largest percentage of workers with experience in 
steel ranging from 30 to 40 years was in plant B. Plant A had the 
largest group with 20 to 30 years’ experience and plant C had the 
largest group with 10 to 20 years in steel. One plant using sodium 
fluoride had the largest percentage of workers with less than 10 years 


31 


iii steel while the other plant using this material had the smallest 
percentage in this duration group. Each plant had more than one- 
fourth the workers with service of 20 years or over. 


Table 7 .—Years worked in the steel industry by male employees in the open- 
hearth department oj 4 steel plants 


Years in steel industry 

All 

plants 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 


Number 

Total_ 

350 

48 

63 

139 

100 

Less than 5. . ... 

56 

3 

12 

23 

18 

5 to 9_ 

67 

6 

9 

32 

20 

10 to 14_ 

49 

5 

6 

30 

8 

15 to 19_ 

41 

8 

8 

14 

11 

20 to 24_ 

42 

10 

7 

10 

15 

25 to 29_ 

34 

10 

5 

7 

12 

30 to 34_ 

30 

4 

9 

8 

9 

35 to 39_ 

18 

1 

5 

8 

4 

40 to 44._ _ .. .. . ..... _ . ... _ 

12 

1 

2 

6 

3 

45 to 49_ 

1 

0 

0 

1 

0 


Percent 

Total_ 

100.0 

100.0 

100.0 

100.0 

100.0 

Less than 5.. _ .. ....... 

16.0 

6.3 

19.1 

16.5 

18.0 

5 to 9_ 

19.2 

12.5 

14.3 

23.0 

20.0 

10 to 14_ 

14.0 

10.4 

9.5 

21.6 

8.0 

15 to 19_ 

11.7 

16.7 

12.7 

10.1 

11.0 

20 to 24_ 

12.0 

20.8 

11.1 

7.2 

15.0 

25 to 29_ 

9.7 

20.8 

7.9 

5.0 

12.0 

30 to 34_ 

8.6 

8.3 

14.3 

5.8 

9.0 

35 to 39_ 

5.1 

2.1 

7.9 

5.8 

4.0 

40 to 44_ 

3.4 

2.1 

3.2 

4.3 

3.0 

45 to 49_ 

.3 

0 

0 

• 7 

0 


Of particular interest in the present study is the length of time work¬ 
ers had been in the open-hearth department of a steel plant. Although 
slightly more than half had been in that department less than 10 years, 
20.3 percent had been in the same location 20 years or over and 5.5 per¬ 
cent had had open-hearth experience of 30 years or over. 


32 
















































Medical Findings 


INTRODUCTION 

Fluorides are regarded as general protoplasmic poisons, but their 
effect is altered according to the chemical compounds and amounts 
involved in the specific exposure. Thus, we see that gaseous fluorides, 
such as hydrogen fluoride and silicon tetrafluoride, are very toxic 
because of their solubility and reactivity. The undissociated hydrogen 
fluoride molecule is capable of penetration of the intact skin and may 
exert a systemic effect, as well as its corrosive local action. 1 

Cryolite (Na 3 AlF 6 ) on the other end of the solubility scale has a low 
toxicity, as do the other almost insoluble fluorides. Since these com¬ 
pounds are not very irritating they are inhaled in large amounts with¬ 
out causing much cough and slowly absorbed to produce chronic pois¬ 
oning or fluorosis. Outstanding symptoms of fluorosis are anorexia, 
vomiting, constipation, dyspnea on exertion, and rheumatic pains. 

The bones usually develop osteosclerosis. There is an abnormal 
calcification of the tendinous muscle attachments, ligaments, and also 
marked periosteal bone formation. Drinking water which contained 
up to 3 parts per million did not cause skeletal sclerosis even in people 
who had been drinking it for a long time. 2 These changes may be the 
cause of some of the rheumatic-like pains. It has been estimated that 
0.1 milligram of fluorine per kilogram of body weight daily may cause 
dental changes in children, and 0.20 to 0.35 milligram of fluorine per 
kilogram of body weight may cause bone changes after several years of 
exposure. 3 

Solutions of hydrogen fluoride and hydrofluosilicic acid are ex¬ 
tremely toxic while relatively easily soluble fluorides and fluosilicates 
are classified as having high toxicity. Sodium fluoride falls in this 
latter group which is intermediate in the toxicity scale. Local corro¬ 
sion is most pronounced from the extremely toxic group but may also 


1 Roliolm, Kaj : Flourine Intoxication. II. K. Lewis, London, 1937. 

2 Hodges, P. C.; Fareed, O. J.; Ruggy, George; and Cliudnoff, J. S.: Skeletal sclerosis and 
chronic sodium fluoride poisoning. J. Am. Med. Ahhoc., 117 : 1938, Dec. C>, 1941. 

3 Roliolm, Kaj: Flourine Intoxication. H. K. Lewis, London, 1937. 


33 




occur from sodium fluoride. Skin changes range from erythema to 
coriaceous changes which may progress to ulcers. Blisters and pus¬ 
tules are fairly common and loosened finger nails are said to occur. 
Irritation of the mucous membranes also occurs and results in sneezing, 
coughing, and chemical bronchitis. Hydrogen fluoride has been shown 
to be a harmful agent as a pulmonary irritant and volatile poison. 4 
Outstanding in the experimental phase is the work done by McClure 
et ah, 5 who showed that up to 4 to 5 milligrams of sodium fluoride can 
be excreted daily without storage or harmful effects. 

Other work indicates that inhaled fluorides are effectively absorbed. 
When absorption is great, a certain amount of storage occurs. Within 
limits, urinary excretion may be used as a measure of fluoride storage 
since the magnitude of urinary fluoride excretion varies directly with 
the amount absorbed. 6 

Acute poisoning from sodium fluoride is not of industrial impor¬ 
tance and occurs almost entirely from accidental or intentional in¬ 
gestion. A lethal dose varies from 5 to 15 grams when taken by mouth. 
It produces a hemorrhagic enteritis which progresses to death from 
shock. Small amounts of sodium fluoride may be swallowed by indus¬ 
trial workers and may cause anorexia, nausea, and vomiting. 

W orkers in the open-hearth department are also exposed to intensive 
heat and radiant energy from molten steel, and various gases from 
the pitch which lines the ingots. There were no heat elfects antici¬ 
pated as the study was done during the winter. 

Radiant energy has long been suspected as a cause of cat aracts. Most 
authorities believe that the infrared rays are the etiological factor al¬ 
though some still suspect ultraviolet. 7 Large exposures of infrared 
have been used experimentally to produce cataracts. 

J. J. Johnstone describes the typical ray cataract as a fairly dense 
discrete posterior polar cataract. Slit lamp examination, as well as 
ophthalmoscopic, is necessary to establish the diagnosis. An attempt 
was made in this study to record all changes in lens opacity so that 
comparison may be made with other industrial groups. In this man¬ 
ner beginning changes can be estimated. 

The fumes which come from the tar or pitch ingot lining contain a 
large amount of acridine. Impure acridine causes burning and itching 
of the mucous membranes which results in a violent sneeze or coiurh. 8 

4 Machle, Willard, and Kitzmillar, Karl : The effects of the inhalation of hydrogen 
fluoride. II. The response following exposure to low concentration. Jour. Ind. Hyg. & 
Toxicol., 17 : 223, Sept. 1935. 

5 McClure, F. J. ; Mitchell, H. H.; Hamilton, T. S.; and Kinser, C. A.: Balances of 
fluorine ingested from various sources in food and water by five young men. Jour. Ind. 
Hyg. d Toxicol., 27 : 159, June 1945. 

6 Machle, Willard, and Largent, E. J. : Absorption and excretion of fluoride. Jour. hid. 
Hyg. & Toxicol., 25 : 112, March 1943. 

7 Johnstone, J. J. : Heat ray cataract. Tr. Ophth. Soc. United Kingdom, 64 : 252, 1945. 

8 Schwartz, Louis ; Tulipan, Louis ; and Peck, S. M. : Occupational Diseases of the Skin. 
Lea and Febiger, Philadelphia, 1947. P. 227, Acridine. 


34 



It may produce erythema and even swelling of the membranes of the 
eyes, nose, and throat. Its effect in this regard is very easily confused 
with that of sodium fluoride. Acridine may sensitize tlie skin to sun¬ 
light and may thus result in dermatitis. 9 

In some preparations of steel, elemental sulfur is introduced into the 
molten steel resulting in the evolution of irritating sulfur dioxide 
fumes. These fumes may also cause irritation of the nose and throat, 
producing cough and simulating the syndrome of other irritating 
gases. 


PROCEDURES 

History and Physical Examination 

The medical study was made as complete as possible in an attempt 
to uncover possible health hazards. The worker's history included a 
detailed occupational record and a review of past history of disease. 
Present symptoms were elicited with special emphasis on the effects of 
fume irritation and suggestions of fluorosis. 

Physical examination was quite complete with special emphasis on 
slight lens opacity and inflammation of the mucous membranes of the 
eyes, nose, and throat. Bony structure and function was checked. 

Every worker had a chest X-ray, as well as an X-ray of his left 
wrist and forearm which included the elbow. The X-ray of the long 
bones was taken to determine whether abnormal changes were present. 

Laboratory Tests 

A. Urine 

Urine specimens were collected from each person examined and 
studied for the following: 

1. Appearance. —Determined by shaking and observing. 

2. Specific gravity. —Determined by Squibb urinometer. 

3. Albumin. —Determined by heat and acetic acid test. 

4. Glycosuria. —Determined by Benedict’s qualitative test. 

5. Microscopic. —A microscopic examination was done only on 
urines exhibiting positive albumin. 

6. Chemical' analysis. —The urine remaining after the clinical anal¬ 
ysis was placed in 8-ounce bottles, labeled with patient’s number, occu¬ 
pation, and date, and analyzed for fluorides. One gram of calcium 
oxide to fix the fluorides and 2 cubic centimeters of formalin, to act as 
a preservative, were added. 


9 Sollmann, Torald : Manual of Pharmacology. 7th ed., W. B. Saunders and Co., Phila¬ 
delphia, 1948. 


35 



B. Blood 


1. Red blood cell coumt. —Blood from finger prick was counted by 
the standard method. 

2. White blood cell count. —Blood from finger prick was counted by 
the standard method. 

3. Hemoglobin. —Hemoglobin was determined by a Haden-Hausser 
clinical model hemoglobinometer. 

4. Differential. —A blood smear was made, stained by 'Wright’s 
method, and differential count made. 

5. Serology. —Blood was obtained by venipuncture and serological 
test for syphilis was done by the State health department. 

6. Sedimentation rate. —Done by Wintrobe method using venous 
blood. 

7. Hematocrit. —Done by using venous blood. 


DISPENSARY VISITS 

Each of the plants included in this study had a completely equipped 
dispensary where occupational injuries and occupational diseases were 
treated. The first time anyone came to the dispensary with a particu¬ 
lar complaint a card was filled out and all subsequent treatments for 
the same complaint were entered on this card. From these records it 
was possible to learn the number of first visits made during the cal¬ 
endar year 1947 by each of the men who were given the physical 
examination by the Public Health Service. The two plants using 
sodium fluoride showed 43.7 and 26.6 percent of the men with no 
visits to the dispensary during the year, while the other two plants 
showed 63.5 and 29.0 percent. Exposure, age, and occupational rates 
cannot be compared for all plants taken as a whole because of the 
extreme interplant differences. The level of dispensary visits in a 
particular plant is apparently more closely related to local attitudes 
toward attendance than to the occurrence of minor injuries. 

In general more frequent dispensary visits were found among the 
younger men and among those with relatively short experience in 
the open-hearth department. For example, 33.7 percent of all men 
with less than 5 years in the open-hearth department had five or more 
dispensary visits during 1947. Only 7 percent of the men with 20 
years or more of experience had this many visits. Again, 50 percent 
of the men under 25 years of age had five or more visits compared with 
3.4 percent of the men 55 years of age or over. 

According to occupation cranemen had the fewest dispensary vis¬ 
its. Seventy-five percent had no visits to the dispensary, 12.5 percent 
had one visit, 7.1 percent had two visits, and 5.4 percent had three 
visits. No crane operators had more than three visits. The percentage 


36 


of persons with five or more visits was 1*2.4 for platform workers, 20.0 
percent for pit workers, and 26.9 percent for tap, charge, and other 
workers. Considering the four plants separately the occupational 
group with the smallest percentage having no visits was pit workers 
in three plants and platform workers in one plant. 

Dispensary visits and sodium fluoride exposure did not appear to 
be related. Moreover, in each of the plants using sodium fluoride the 
group of workers with the highest exposure showed the largest per¬ 
centage of men with no or only one dispensary visit. 

Occupational injuries or diseases were the reason given for 56.5 
percent of the dispensary visits in plant A, for 83.8 percent of the 
visits in plant B, for 96.6 percent of the visits in plant C, and 80.1 
percent of the visits in plant I). Occupational diseases were recorded 
in only one plant, amounting to 3.7 percent of all dispensary visits 
in that plant. One-third of these were said to be heat cramps and 
two-thirds were attributed to carbon monoxide gas from the furnaces. 
None was linked with sodium fluoride although this plant used the 
highest concentrations of sodium fluoride. The nonoccupational cases 
treated in the various plant dispensaries were obviously not con¬ 
nected with occupational exposure. They included for the most part 
injuries received at home or on the way to work and a few cases of 
colds or influenza. 


SICK ABSENCES 

Information was secured regarding sickness and nonindustrial in¬ 
juries causing disability lasting 8 calendar days or longer for male 
open-hearth workers examined in the four steel plants. When re¬ 
sults from the present study are compared with those from other 
plants it must be remembered that persons who were sick at the time 
of the medical examination were not included. This would tend to 
artificially lower these rates. The average annual number of cases 
of sickness and nonindustrial injury per 1,000 males was 69.7 for 
all ages, ranging from 61.1 in plant C to 84.2 in plant D. This may 
be compared with a rate of 79.8 in another large steel company re¬ 
porting to the Public Health Service. Persons under 45 years of 
age had a frequency rate of 84.6 while persons 45 years of age or 
over had a rate of 60.0. The average annual number of days of dis¬ 
ability per person was 1.77 for all males; for the younger age group 
it was 2.02 and for the older age group it was 1.61. The average 
number of days per case were 25.3, 23.8, and 26.7, respectively. 

The diagnoses reported fail to indicate an above-average frequency 
of any particular disease. Comparison with the other steel company 


37 


mentioned above shows the following annual frequency rates per 
1,000 males by cause: 


Diagnosis 

This study 

Other steel 
company 

All diagnoses 

69. 7 

79. 8 

Nonindustrial injuries 

12. 1 

9. 4 

Sickness.- _ 

57. 6 

70. 4 

Respiratory disease. 

15. 2 

24. 1 

Digestive disease . 

9. 1 

12. 6 

Nonrespiratory-nondigestive disease - _ _ 

33. 3 

33. 7 


It appears that the present company had a less favorable experi¬ 
ence with nonindustrial injuries, but a decidedly more favorable ex¬ 
perience with respiratory diseases, and a somewhat more favorable 
experience with digestive diseases. Nonrespiratory-nondigestive dis¬ 
eases occurred with almost the same frequency. The 11 cases grouped 
under nonrespiratory-nondigestive diseases included the following: 
Diseases of the circulatory system two cases, genitourinary diseases one 
case, rheumatic disease three cases, diseases of the sense organs two 
cases, and diseases of the skin three cases. There was no appreciable 
difference in the type of case reported by the fluoride-using and the 
nonfluoride-using plants. 

The frequency of sickness and nonindustrial injuries per 1,000 males 
according to occupation was 90.9 for cranemen, 69.6 for pit workers, 
64.9 for platform workers, and 60.2 for tap, charge, and other workers. 
A break-down by plant shows that the high rate for cranemen is pro¬ 
duced by the experience of the one plant which never had used sodium 
fluoride. In the two plants using sodium fluoride no cranemen had 
been absent 8 days or longer because of sickness or nonindustrial 
injury. 


PREVIOUS ILLNESSES 

Open-hearth workers were questioned whether they had ever suf¬ 
fered from certain types of illnesses. The types selected were such 
that reasonably accurate answers could be expected from the persons 
giving the information. Attacks of illness recalled were as follows: 
Pneumonia 12.9 percent, rheumatism 12.6 percent, skin trouble 12.8 
percent, and asthma 2.0 percent. Comparable percentages for cemented 
tungsten carbide workers were 17.3, 21.9, 30.8, and 4.8. In every in¬ 
stance the latter group of workers had a substantially higher percent¬ 
age with attacks reported than did open-hearth workers. Shipyard 


38 














workers showed larger percentages for pneumonia, rheumatism, and 
asthma, but a lower percentage for skin trouble. Considering the long 
time which these men had worked in the steel industry and in the open- 
hearth department their occupation has not apparently led to an excess 
of pneumonia. Tuberculosis was reported by one open-hearth worker 
(0.3 percent) although in each of the two other industries mentioned 
above it was named by 1.2 percent. 

The two plants using sodium fluoride had lower percentages report¬ 
ing pneumonia than the other plants, namely 8.6 and 12.5 percent 
compared with 14.3 and 18.0 percent. The percentage of workers who 
had had skin trouble did not vary greatly, being 14.6 and 12.9 in the 
fluoride-using plants and 12.0 and 9.5 percent in the other plants. Simi¬ 
lar percentages for rheumatism were 10.8 and 12.5 percent compared 
with 18.0 and 7.9 percent. The percentage of workers who reported one 
or more colds during the previous year was less in the fluoride-using 
plants: 33.3 and 29.7 percent, while the other plants reported 45.9 
and 43.9 percent. 


HISTORY AND SYMPTOMS 

Every worker was given the opportunity to freely mention and 
discuss any symptom that might have presently or recently been 
bothering him. All complaints were carefully noted and special atten¬ 
tion was given to such symptoms as headache, nausea, vomiting, pain 
or cramps of muscles, joints, or abdomen, weakness, fainting, restless¬ 
ness, poor appetite, hiccough, diarrhea or constipation, and thirst; any 
of which might have been overlooked. 

Close examination of the data revealed a wide variation and scarcity 
of symptoms. The most common group of symptoms included cough, 
upper respiratory complaints, such as hoarseness, sore throat, stopped- 
up nose, burning sensation of the trachea, throat or nose, and such 
complaints as scratching, burning, or watering of the eyes. 

Seventy-four percent of all the 350 workers were free of cough, up¬ 
per respiratory, or eye complaints of the above-mentioned types, alone 
or in combination. Fifty men complained of cough alone, 17 of cough 
with upper respiratory irritation, 21 of upper respiratory irritation 
only, 3 of eye irritation only, and 1 of cough and eye irritation in com¬ 
bination. 

It is interesting to note that among those working with the smaller 
amounts of sodium fluoride, 25 percent mentioned these latter special 
symptoms; where the fluorides were formerly used 24 percent men¬ 
tioned the symptoms; where the greater amount of fluorides was 
used 19 percent complained; and in the control group 39 percent 
mentioned these discomforts. Cough alone was mentioned over twice 


39 


as frequently as cough and upper respiratory complaints together, or 
upper respiratory irritation alone. Eye irritation alone or in com¬ 
bination with cough occurred in less than 1 percent in either case. At 
the concluson of what might be called the voluntary period of dis¬ 
cussion or inquiry, the worker was asked if the fumes, dusts, or smokes 
or anything about the job bothered him. The usual replies would men¬ 
tion sneezing, coughing, gagging, and choking as the symptoms. Burn¬ 
ing of the eyes, nose, or throat was seldom mentioned. Generally, these 
symptoms were admitted on close inquiry only. They would be de¬ 
scribed as being of 5 to 15 minutes’ duration or until the worker could 
get out of the smoke or dust. Only very occasionally would these dis¬ 
comforts last over an hour and it was rare to hear of the effect lasting 
over 24 hours. 

No correlation of any significance appeared to result from the analy¬ 
sis by age groups. The old and young appeared to be equally affected 
or non affected by exposures on the job. 


PHYSICAL EXAMINATION 


General Discussion 

In general, the development and nutrition of all four groups was so 
similar that it made any effect by sodium fluoride seem unlikely. No 
significant body-weight deviation was noted. The oral temperatures 
of the workers in all four groups fell within close limits. No signifi¬ 
cant pallor was noted in any of the workers examined. The skeletal 
and muscular development was not significantly different in any of 
the four groups examined. A moderately large number of grooved 
chests with or without pigeon breasts was noted but the deformity 
seemed to be due to nutritional defects in infancy. No rigidity, 
atrophy, or paralysis of muscles was noted. Joint function was not 
impaired either in the groups exposed to sodium fluoride or in the 
controls. 

Weight Deviation 

The percent deviation of each open-hearth worker’s weight from the 
weight of men of similar height and age was calculated from life insur¬ 
ance data. Thus it is possible to determine what proportion were 
underweight or overweight. As might be expected the percentage 
(7.1) of the open-hearth workers who were 15 percent or more under¬ 
weight is less than for most industrial groups studied. A larger pro¬ 
portion underweight were found among cemented tungsten carbide 
workers, coal miners, smelter workers, and shipyard workers. Only 
metal miners and truck drivers had a smaller percentage underweight. 


40 


On the other hand, 16.8 percent of the open-hearth workers were 15 
percent or more overweight. This exceeds the percent overweight 
for shipyard workers, coal miners, metal miners, and smelter workers. 

Plant differences in the percent underweight show that plant D, 
which had never used sodium fluoride, was the most unfavorable, while 
plant B, which had not used sodium fluoride recently, was the most 
favorable. (See appendix, table B.) The percentage of males 15 
percent or more overweight was as follows: Plant A, 17.4; plant B, 
-T1; plant C, 12.6; and plant D, 17.6. As a whole, open-hearth work¬ 
ers were a strong, muscular group, characteristic of men in an industry 
which requires heavy physical labor. 

Eyes 

The eyes were closely observed for possible changes. Conjunctivitis 
and corneal opacities were rare and not related to sodium fluoride 
exposures. 

Irregularities of the iris were most often present when some definite 
cause could be found such as neurosyphilis or as the result of an 
operation. 

The lenses were carefully observed under direct and oblique illumina¬ 
tion. Slight increases of opacity were recorded but it was usually 
impossible to decide whether this was the result of cataract formation 
or merely senile change. The amount of progression in the next few 
years would demonstrate whether it is actually a cataract in forma¬ 
tion. Slight lens opacity was highest in cranemen as a group; 30.4 
percent of them being affected as compared to 13.6 percent of the pit¬ 
men, who were the next highest group. The highest incidence among 
cranemen was found in the control plant which tends to minimize 
fluoride effect as the cause. Analysis of the incidence of slight lens 
opacity related to degree of exposure to sodium fluoride and duration 
of work must be carefully considered as the specific job of the individ¬ 
ual and his age are related respectively to those factors. There was 
no increase in lens opacity in workers less than 45 years of age. 

Slight opacity was found in 20.8 percent of the workers in the 45 to 
54 age group and in 42.4 percent of those 55 years and older. This is 
certainly evidence that it is an age effect rather than the result of 
toxicity. The role of infrared radiation should be evaluated in the 
future since the older men have had a longer exposure to this and the 
changes may be in part due to this. 

Visual Acuity 

Visual acuity among open-hearth workers was measured by the Key¬ 
stone test. If a worker came to the examination wearing glasses he 


41 


was tested with his glasses on so that the results should approximate 
visual ability under normal working conditions. 

Table 8 shows the visual acuity of each eye separately for males of 
specified ages. The percentage of males with 20/20 vision in both eyes 
was 60.1, under 40 years of age; 26.5, 40 to 49 years; and 6.6, 50 years 
or over. A better measure of visual ability is the possession of 20/20 
vision in at least one eye. The percentage with this visual acuity for 
the above age groups was 86.9, 49.4, and 10.5. Thus it appears that 
few open-hearth workers 50 years of age or over had normal vision in 
either eye. 


Table 8 .—Distribution oj male open-hearth workers in 4 steel plants by 
visual acuity ( Keystone ) oj each eye according to age 





Visual acuity right i 

eye 


Visual acuityjleft eye 

Total 








20/20 or 
better 

20/33 

20/45 

20/60 

20/75 
or less 

Not 

stated 


Under 40 years 

Total....... 

153 

105 

46 

2 

0 

0 

0 

20/20 or better_ 

120 

92 

27 

1 

0 

0 

0 

20/33_ 

20 

10 

18 

1 

0 

0 

0 

20/45_ 

2 

1 

1 

0 

0 

0 

0 

20/60____ 

0 

0 

0 

0 

0 

0 

0 

20/75 or less_ 

1 

1 

0 

0 

0 

0 

0 

Not stated_ _ 

1 

1 

0 

0 

0 

0 

0 




40 

to 49 years 



Total....... 

83 

32 

26 

15 

5 

5 

0 

20/20 or better_ _ 

31 

22 

6 

2 

0 

1 

0 

20/33___ 

29 

9 

14 

4 

2 

0 

0 

20/45___ 

13 

0 

5 

7 

1 

0 

0 

20/60_____ 

7 

1 

1 

2 

2 

1 

0 

20/75 or less_ 

3 

0 

0 

0 

0 

3 

0 

Not stated_ 

0 

0 

0 

0 

0 

0 

0 


50 years or over 

Total_____ 

114 

10 

27 

29 

22 

18 

8 

20/20 or better_ 

8 

7 

1 

0 

0 

0 

0 

20/33_ 

26 

2 

13 

10 

1 

0 

0 

20/45_ 

30 

0 

12 

8 

7 

3 

0 

20/60_ 

22 

1 

0 

9 

8 

4 

0 

20/75 or less.__ 

19 

0 

0 

2 

6 

11 

0 

Not stated_ ... .. ... 

9 

0 

1 

0 

0 

0 

8 


Comparison with other industrial populations shows that open- 
hearth workers have a higher percentage of males with visual acuity 
of 20/20 in at least one eye than do shipyard workers, truck drivers, 
felt hat workers, or cemented tungsten carbide workers in the age 
groups under 30 years and 30 to 39 years. In the 40 to 49 and the 
50-year or over age groups the position is reversed and open-hearth 
workers make a poorer showing. For example, age 40 to 49, the 


42 































































percent with normal vision in at least one eye is 80 for shipyard 
workers and 87 for cemented tungsten carbide workers, blit falls to 
40 for open-hearth workers. In the 50-year or over group the con¬ 
trast is much greater. The first two groups had 05 percent and 81 
percent normal whereas open-hearth workers showed less than 10 
percent. It should be remembered that these readings are based on 
actual vision at work, either natural or assisted. Sixty-one percent 
of the cemented tungsten carbide workers 50 years of age or over 
wore glasses when tested, but only 35 percent of the open-hearth work¬ 
ers of this age group were so tested. Differences with regard to visual 
requirements in the two industries might mean that open-hearth 
workers did not need the same quality of visual acuity, hence a smaller 
percentage would have secured glasses. 

The percentage of males with visual acuity of ' 20/20 in one or both 
eyes varied according to age and plant, as follows: 


Age 

Plant A 

Plant B 

Plant C 

Plant D 

Under 30 years, _ __ 

60. 7 

100. 0 

84. 4 

100. 0 

30 to 39 years , _ ,_ _. _ 

81. 8 

94. 4 

86. 8 

75. 0 

40 to 49 years. _ _ _ _ 

69. 2 

31. 3 

53. 3 

38. 5 

50 years or over _ _ _ _ 

25. 0 

8. 7 

2. 9 

15. 0 


In each plant there was a rapid decrease in the percentage of males 
with normal visual acuity in at least one eye with advancing age. This 
change was most marked in plant C and least marked in plant A, 
both of which use sodium fluoride. 

Good eyesight is especially necessary in certain occupations, for 
example, cranemen who handle ladles containing molten steel. It 
is of interest to note that 25 percent of the cranemen 40 to 49 years 
of age had visual acuity in the better eye of only 20/45 or less. At 50 
years of age or over 40.0 percent of the cranemen had vision this 
poor. Seven men operating cranes at the time of this study had visual 
acuity in the better eye of 20/60 or less. The occupation showing the 
largest proportion of men with poor vision (20/45 or less in the better 
eye) was tap, charge, and other workers. Platform workers had the 
best vision when classified in this manner. 


Nose 

Nasal mucosa was carefully observed for signs of damage or irri¬ 
tation. Only occasionally was any inflammation found and this was 
slight. No septal perforation was found in any of the workers. 


43 
















Throat 

The prevalence of pharyngitis among the workers in two plants 
was determined according to their exposure to sodium fluoride. A 
scale consisting of four degrees of exposure, based on the concentration 
of fume and length of time in this concentration, was established on 
the basis of the engineering findings. The lowest percentage (52.0) 
of normal throats was found in the greatest degree of exposure. Mild 
pharyngitis was found to increase with increasing exposure ranging 
from 8.3 percent in the first degree to 20.0 percent in the fourth degree. 
Cough alone tended to decrease with increasing exposure. From this 
it seems evident that cough is not related to sodium fluoride concen¬ 
trations. Pharyngitis, with or without cough, tended to increase with 
increasing exposure; the percentages in the first degree and in the 
fourth degree being 10.4 and 36.0 for pharyngitis without cough and 
22.9 and 48.0 for pharyngitis with cough. 

Workers in the other two plants were said to have no or minimal 
exposure to sodium fluoride. This material had never been used in 
one plant but had been used at some time in the past in the bther plant. 
Among workers with no and minimal exposures 67.5 percent had nor¬ 
mal throats and 14.1 percent had mild pharyngitis. Pharyngitis with 
cough was found in 7.4 percent of these workers, cough alone in 17.2 
percent and pharyngitis without cough in 20.9 percent. 

When individual plants were considered it was found the plant 
where sodium fluoride had never been used had the highest percentage 
of workers with pharyngitis. No age trend was apparent in con¬ 
nection with these findings. 

In conclusion it appears that no severe pharyngeal damage results 
from exposure to sodium fluoride. A slight degree of pharyngitis 
may possibly be caused by sodium fluoride, tar smoke, or sulfur di¬ 
oxide fumes but it is difficult to separate the effects of these three. 

Cardiovascular 

Heart disorders were classified under the same broad etiological 
headings followed in certain other Public Health Service investiga¬ 
tions of industrial workers. This classification is based on the outline 
prepared by the heart committee of the New York Tuberculosis and 
Health Association, 10 sponsored by the American Heart Association 
and discussed by Hedley. * 11 Many of the workers observed and diag¬ 
nosed as having arteriosclerotic or hypertensive heart disease were 
comparatively symptom free, especially among younger individuals 
and could, possibly , be classified as preclinical or potential heart dis- 


10 Criteria for the Classification and Diagnosis of Heart Disease. 3d ed. New York 
Tuberculosis and Health Assoc., New York, 1932. 

11 Hedley, O. F. : Studies of Heart Disease Mortality. Pub. Health Bull. No. 231. 


44 



oast*. A systolic blood pressure of more than 150 millimeters Hg and 
a diastolic pressure of more than 100 was interpreted as showing 
essential hypertension. 

As shown in table 9 arteriosclerotic-hypertensive heart disease was 
more frequently observed among open-hearth workers than among 
other groups of workers recently studied by the Public Health Service. 

1 lie excess for open-hearth workers is most marked for the age groups 
25 to 34 and 35 to 44 years. With respect to the incidence of rheumatic 
heart disease, open-hearth workers do not differ greatly from the 
others. 


Table 9 .—Percentage of male open-hearth workers in the steel industry 
with arteriosclerotic-hypertensive heart disease or rheumatic heart disease 
classified according to age and compared with other male industrial 
workers 


Age in years 


Industrial group 


Open-hearth workers... 

Cemented tungsten carbide workers 1 

Shipyard workers 2 __ 

Utah coal mine workers 3 * .. 

Utah metal mine workers . 

Utah smelter workers 5 * .. 

Pottery workers 8 --- 

Storage battery workers 7 . . 

Truck drivers 8 .-.— 


Open-hearth workers . - 

Cemented tungsten carbide workers 

Shipyard workers.. 

Utah coal mine workers. 

Utah metal mine workers.. 

Utah smelter workers. 

Pottery workers--- 

Storage battery workers.. 

Truck drivers.. 


Total 

15 to 24 

25 to 34 

35 to 44 

45 to 54 

55 or 
over 

Percent with arteriosclerotic-hypertensive 
heart disease 

17.4 

0.0 

5. 6 

9.9 

24.8 

39.0 

3.9 

. 5 

1.5 

2.8 

7.3 

22. 1 

9.4 

. 7 

3. 1 

9. 6 

17.3 

57.6 

5. 7 

1. 3 

2.9 

2. 1 

11. 4 

35.7 

ft. 7 

4.8 

1.2 

7. 6 

13.5 

31. 1 

8.6 

3. 1 

1. 7 

4. 4 

14.3 

37.2 

4.5 

0 

.9 

2.2 

11.3 

25. 5 

12.3 

0 

1. 6 

7.4 

29. 9 

41.3 

6. 1 

5.2 

4.7 

7. 1 

18.4 

25. 0 


Percent with rheumatic heart disease 


2. 6 

0.0 

3.4 

0.0 

4.0 

3.4 

.9 

1 . 6 

.9 

.5 

.6 

.9 

1. 6 

3. 1 

1.6 

1.3 

.3 

1.2 

2.8 

2.5 

.6 

4.2 

4.5 

3.6 

2.3 

2.4 

1.9 

2.3 

3.8 

2.2 

. 6 

0 

1.1 

.3 

. 7 

. 7 

1.0 

1. 1 

. 7 

1. 1 

1.8 

0 

1.2 

0 

2.0 

1.4 

.6 

0 

1.7 

0 

1.9 

2.6 | 

0 

0 


Total number of workers examined 


Open-hearth workers _ - _ - 

350 

20 

89 

81 

101 ! 

Cemented tungsten carbide workers _ _ 

1,533 

191 

658 

394 

177 

Slhjpvard workers ... 

2, 835 

421 

1, 138 

799 

307 

XT tab coal mine workers _ _ _ .. 

507 

79 

170 

142 

88 

Utah metal mine workers .. . . 

727 

83 

323 

172 

104 

Utah smelfer workers ... 

1,391 

130 

458 

387 

279 

Pntterv workers _ ____ 

1.627 

350 

549 

370 

221 

Storage battery workers _ _ 

757 

74 

246 

217 

157 

Truck drivers ...-.-. —— 

886 

135 

485 

224 

38 


59 

113 

170 

28 

45 

137 

137 

63 

4 


1 Unpublished data. 

2 Pub. Health Bull. No. 298. 

3 Pub. Health Bull. No. 270. 

* Pub. Health Bull. No. 277. . _ , XT <• u ■. f ■ „ 

5 Working Environment and Health of \\ orkers in Bituminous ( oal Mines, Non ferrous Metal Mines, 
and Nonferrous Smelters in Utah, by Division of Industrial Hygiene* l SPHS f and l tah btate Board 
of Health, Nov. 1940. 

8 Pub. Health Bull. No. 244. 

7 Pub. Health Bull. No. 262. 

8 Pub. Health Bull. No. 265. 


45 























































Arteriosclerotic-hypertensive heart disease was found present in 17.4 
percent of the 350 open-hearth workers. The percentage in individual 
plants ranged from 8.3 to 22.2, with the lower incidence in the two 
sodium fluoride-using plants. Essential hypertention accounted for 
11.7 percent of the workers examined. When individual plants are 
considered it is found that 6.2 and 10.1 percent of the workers in the 
two sodium fluoride-using plants, 11.0 percent of the control plant and 
20.6 percent of those working in the plant where sodium fluoride had 
been used in the past, had essential hypertension. 

Less than 1 percent of the total employees were considered to be 
suffering from decompensated hypertensive heart disease while 4.9 
percent were said to have the compensated type. The control plant 
showed the highest percentage with the compensated type of this dis¬ 
ease (9.0 percent) while one of the fluoride-using plants had none 
although it had the highest percentage of the decompensated type (2.1 
percent). 

Only one case of syphilitic heart disease was suspected. There were 
functional heart murmurs in 3.1 percent of the workers examined. 
The highest incidence of this was in the two sodium fluoride-using 
plants while the control plant had none. 

Rheumatic valvular disease was suspected in 2.6 percent of the total 
workers examined. In the two plants using sodium fluoride the in¬ 
cidence was less than in the two nonfluoride-using plants: 2.1 percent 
and 2.2 percent in the former and 3.0 percent and 3.2 percent in the 
latter. 

No cardiovascular change was apparent as a result of sodium fluoride 
exposure in the manufacture of steel. 


Blood Pressure 

The mean systolic blood pressure of males working at the open 
hearth was 132.7 which is higher than that of certain other industrial 
groups studied by the Public Health Service. (See table 10.) These 
latter were 10,000 Industrial Workers 12 with a mean of 129, truck driv¬ 
ers with 128, shipyard workers with 126, Utah soft coal and metal mine 
workers each with 125, and cemented tungsten carbide workers with 
122. Mean diastolic blood pressure for open hearth workers was 84, 
which was also the highest of the groups mentioned above. Truck 
drivers averaged 83, Utah soft coal mine workers 81, Utah metal mine 
workers 80, shipyard workers 78, 10,000 Industrial Workers 77 and 

Public Health Bulletin No. 162. 


46 



cemented tungsten carbide workers 74; as will be seen when table 10 is 
studied. 


I able 10. Comparison oj mean systolic and diastolic blood pressures of 
males in open-hearth department of 4 steel plants and of other industrial 
groups 


Ago 

(years) 

Open- 

hearth 

workers 

Ce¬ 
mented 
tung¬ 
sten 
carbide 
work¬ 
ers 1 

Ship¬ 
yard 
work¬ 
er^ • 

Utah 
metal 
mine 
work¬ 
ers 3 

Utah 
soft coal 
mine 
work¬ 
ers 4 

Truck 

drivers* 

10,(MX) 
indus¬ 
trial 
work¬ 
ers • 


Mean systolic blood pressure 

Total___ 

133 

122 

126 

125 

125 

128 

129 

Under 25... 

122 

113 

117 

124 

122 

126 

123 

25 to 29_ 

124 

118 

123 

123 

124 

129 

126 

30 to 34 _ . 

126 

121 

123 

122 

124 

129 

127 

35 to 39____ 

127 

120 

126 

122 

122 

127 

128 

40 to 44 _ .. 

131 

122 

127 

127 

126 

128 

130 

45 to 49 ___ 

132 

127 

131 

127 

123 

132 

135 

50 or over____ 

144 

137 

140 

135 

134 

142 

142 


Mean diastolic blood pressure 

Total ....... 

84 

74 

78 

80 

81 

83 

77 

Under 25....... 

77 

67 

72 

78 

78 

80 

72 

25 to 29 _ 

81 

72 

77 

78 

79 

82 

75 

30 to 34_ 

82 

73 

77 

77 

81 

84 

77 

35 to 39 ...... 

82 

75 

80 

78 

80 

82 

79 

40 to 44 . . 

85 

78 

80 

84 

84 

83 

80 

45 to 49 _____ _ 

85 

78 

82 

83 

81 

88 

81 

50 or over___ 

87 

81 

85 

87 

86 

88 

83 


1 Unpublished data. 

2 Pub. Health Bull. No. 298. 

3 Pub. Health Bull. No. 277. 

4 Pub. Health Bull. No. 270. 
* Pub. Health Bull. No. 265. 
6 Pub. Health Bull. No. 162. 


The mean systolic blood pressures for males in the fluoride-using 
plants were T28.4 and 131.9 and for the nonfluoride-using plants they 
were 133.0 and 135.7. As shown in appendix, table C, plant D had the 
highest mean systolic and diastolic blood pressures in the age groups 
under 25 years, 25 to 29 years, 30 to 34 years, 45 to 49 years, and 65 years 
or over. 

Arterial hypertension (systolic blood pressure in excess of 150 milli¬ 
meters Hg) was found in only 1.9 percent of the open-hearth workers 
20 to 29 years of age as compared with 4.2 percent of the 10,000 Indus¬ 
trial Workers of the same age who had the highest percentage. In all 
of the industrial groups this condition increased with age although 
the percentage of open-hearth workers 60 to 69 years of age was 
slightly less than those 50 to 59 years. Table 11 shows the fluctuation 
with age for the several groups of industrial workers. 


47 

















































Table 11 .—Percentage of male open-hearth workers in 4 steel plants with 
arterial hypertension 1 according to age, compared with other male 
industrial workers 


Industrial group 

20 to 29 

30 to 39 

Vge in year 

40 to 49 

s 

50 to 59 

60 to 69 


Percent with arterial hypertension 

Open-hearth workers_ _ 

1.9 

6.1 

15.7 

35.2 

33. 3 

Cemented tungsten carbide workers 2 __ . 

1.4 

2.3 

7. 1 

16.1 

34. 0 

Shipyard workers 3 _ _ _ . __ _ 

2.3 

3.9 

7.7 

16. 7 

34. 1 

Utah workers 4 __ _ _ 

2.2 

1.9 

5.6 

21.6 

31.8 

Pottery workers 5 _ ... .... __... 

3.2 

5.8 

13.7 

21.2 

43. 1 

10,000 male industrial workers 6 _ _ _ 

4. 2 

7.3 

16.4 

28.5 

47.9 

Storagebattery workers C.. __ . .. ... _ 

3.3 

6.8 

18. 7 

29.5 

45.2 


Total number of workers examined 

Open-hearth workers_ _ 

53 

99 

83 

91 

21 

Cemented tungsten carbide workers.. ... ... . . 

505 

573 

252 

137 

50 

Shipyard workers. .. . . . _ _ 

688 

1,192 

507 

216 

82 

Utah workers. ... ... ._ .. ... ...___ 

764 

838 

570 

329 

88 

Pottery workers.__... _ _ _ 

569 

447 

256 

160 

51 

10,000 male industrial workers . _ _ 

3, 248 

3, 293 

1,947 

818 

234 

Storagebattery workers_ .... _ ...... 

182 

221 

219 

95 

31 


1 Refers to systolic blood pressure in excess of 150 millimeters Hg. 

2 Unpublished data. 

3 Pub. Health Bull. No. 298. 

4 Working Environment and Health of Workers in Bituminous Coal Mines, Nonferrous Metal Mines, 
and Nonferrous Smelters in Utah, by Division of Industrial Hygiene, USPHS, and Utah State Board of 
Health, Nov. 1940. 

5 Pub. Health Bull. No. 244. 

6 Pub. Health Bull. No. 1132. 

2 Pub. Health Bull. No. 262. 


Skin 

Many of t he common skin disorders such as acne vulgaris were noted, 
but only a few cases suggesting the possibility of fluoride dermatitis 
were seen. One of these cases showed purple-red patches on the wrists 
considered to be post inflammatory, possibly as a result of sodium 
fluoride dermatitis. No vesiculation, ulceration, pruritis, or necrosis 
was seen as might have been expected from sodium fluoride damage. 
It appears that sodium fluoride plays only a very minor role, if any, 
in causing dermatitis among these workers. Irregularities, mottling, 
pitting or curving of the nails described by Spira 13 and others as an 
early sign of fluorosis were not noted. 


X-RAY INTERPRETATIONS 


General Discussion 

The classification used in other investigations of the Public Health 
Service was selected to describe the appearance of the chest X-ray 
films. The lung-field markings were divided into linear, granular, 
and nodular as follows: 


13 Spira, Leo ; Mottled nails. An early sign of fluorosis. Jour. H\jg., 43 : 69, Jan. 1943. 

48 










































Linear. Normal luiii; markings ami lirst dngrnn nxaggnration of linear pul¬ 
monic markings. Second degree exaggeration of linear pulmonic markings, with 
or without heading. 

(Irnnular. First degree diffuse ground glass or grainy appearance, not obliter¬ 
ating linear markings. Second degree diffuse ground glass or grainy appearance, 
obliterating linear markings. 

Aodtt/f/r.—First degree disseminated nodules up to size of miliary tubercles. 
Second degree disseminated nodules exceeding 1 millimeter in size, emphysema 
present, usually. 

I able 12 shows the percentage of white males in the open-hearth de¬ 
partment whose chest X-ray revealed exaggerated lung-field markings 
of first degree ground glass or greater compared with other industrial 
groups. Age specific comparisons indicate that open-hearth workers 
had the most unfavorable experience among workers 25 to 34 years of 
age, but among workers 35 to 44, 45 to 54, and 55 years of age or over 
they made a more favorable showing than Utah metal mine and coal 
mine workers. For each age group over 24 years shipyard workers 
and cemented tungsten carbide workers showed lower percentages with 
ground glass or greater markings than did open-hearth workers. 


Table 12 .—Percentage of white males in the open-hearth department of 
4 steel plants whose chest X-rays showed exaggerated lung-field markings 
of first degree ground glass or greater, compared with other industrial 
groups, hy age 


Age (years) 

Open- 

hearth 

workers 

Cemented 
tungsten 
carbide 
workers 1 

Shipyard 
workers 3 

Utah soft 1 f.j 11 , 
coal mine 

workers 4 

Utah 
smelter 
workers 5 

Total_ 

12.0 

2.4 

3.2 

9.0 14.2 

6.4 

15 to 24_ 

0 

.5 

.5 

0 0 

0 

25 to 34___ 

5.4 

1.0 

3.0 

1.8 3.8 

1.1 

35 to 44 . . ... _ 

10.4 

2.0 

3.0 

11.7 21.7 

7.3 

45 to 54___ 

18.5 

6.8 

6.1 

21.2 36.3 

13.7 

55 or over___ 

16.3 

8.0 

6.1 

25. 9 35. 5 

13.2 


1 Unpublished data. 

2 Pub. Health Bull. No. 298. 

3 Pub. Health Bull. No. 270. 

* Pub. Health Bull. No. 277. 

5 Working Environment and Health of Workers in Bituminous Coal Mines, Nonferrous Metal Mines, 
and Nonferrous Smelters in Utah, by Division of Industrial Hygiene, USPHS, and Utah State Board 
of Health, Nov. 1940. 


As may be observed from appendix, table D, there is no indication 
that the use of fluoride had any influence on the lung-field findings. 
As the granular markings are divided into first- and second-degree 
stages, the latter and those of the nodular group will be described 
more specifically in the next section. 


Symptoms and Physical Findings Associated With Marked Granular and 
Nodular Lung-Field Markings 

Six X-ray films were rated as showing second degree granular lung- 
field markings. In no instance was the film considered in this ad- 


49 
























vanced stage of fibrosis if linear lung-field markings were visible. 
Previous studies by the Public Health Service of industrial environ¬ 
ments and workmen have demonstrated that a diagnosis of silicosis 
was made on a basis of second degree ground glass lung-field mark¬ 
ings as shown by a satisfactory X-ray film of the chest, if supported by 
symptoms and/or physical findings excluding other diseases accom¬ 
panying such chest X-ray markings, and accompanied by an occupa¬ 
tional history revealing a prolonged exposure to dust containing silica. 

Two of the six cases did not have one or two of the three factors in 
sufficient length of work exposure accompanied by supporting sympto¬ 
matology or physical disability to warrant a diagnosis of silicosis 
suspected with such lung-field markings. Four of the workmen with 
second degree granular lung-field markings were considered as hav¬ 
ing early first degree silicosis. Their case histories are outlined below : 

1. 25 years at open hearths. 

2 years in iron foundry. 

3 colds in past 12 months. 

Frequent pains in hips, legs and arms. 

Cough. 

Hoarseness. 

Thin. 

Blood pressure 92/54. 

GG 2 with obliterated angles. 

2. 37 years at open hearths. 

Stomach swells with gas. 

Thin. 

Blood pressure 126/86. 

Tonsils infected. 

Pharynx slightly inflamed. 

GG 2 with hilar calcification on the right and mild emphysema. 

3. 5 years at open hearths. 

8 years in brick and tile plants (kiln placer). 

7 years in coal mines (loader). 

1 year in pottery (mold burner). 

Bronchitis for 25 years. 

Sinus infection in 1942. 

Cough. 

Thin. 

Blood pressure 172/90. 

Hypertensive heat disease—compensated. 

GG 2 with thickened interlobular markings. 

4. 27 years at open hearths. 

Uses cough drops. 

Pneumonia in 1946 and 1947. 

Asthma for years. 

Dyspnea for years. 

Cough. 

Thin. 

Barrel chest and overexpanded. 

Percussion—hyperresonant. 


50 


Auscultation—wheezing throughout. 

Blood pressure 1(30/66. 

GG 2 with hilar and parenchymal calcification on the left. 

1 wo workers presented X-ray films which assumed a first-degree 
nodular appearance. On the basis of the occupational exposure, symp¬ 
toms, physical findings, and roentgenological interpretations they were 
diagnosed as silicosis I. Their case histories are as follows: 

1. 31 years at open hearths. 

7 years in foundries (molder helper). 

Lumbago in 1938. 

Medium build and nutrition. 

Pigeon and grooved chest. 

Blood pressure 130/86. 

Nodular 1 with hilar calcification on right. 

2. 31 years at open hearths. 

4 years in hard coal mines (picking slate). 

Uses cough medicine. 

Sinus infection for 2 years. 

Dyspnea for few years. 

Occasional cough in daytime. 

Medium build and nutrition. 

Blood pressure 138/88. 

Pulmonary Tuberculosis 

A number of chest X-ray films with varying degree of abnormal 
markings were reviewed by a member of the staff of the Tuberculosis 
Control Division of the Public Health Service. It was believed that 
five of the films warranted a classification of tuberculosis. After a 
subsequent review of the films, histories, and physical findings, two 
were considered to be probably active; one moderately advanced and 
the other far advanced. The other three were classified as minimal 
with uncertain activity. It was recommended that the latter three 
cases be restudied by the workers’ private medical consultants after 
a 3 months’ interval. It was interesting to note that four of the five 
were workers from the control plant. The two “active” cases fur¬ 
nished either a suggestive history or physical findings, or both. Their 
laboratory findings were essentially negative. 

Of the less suspiciously active cases one had negative past and pres¬ 
ent medical history and physical examination. The red blood count 
was 4,600,000 (differential: neutrophils segmented 38, neutrophils 
bands 2, lymphocytes 53, monocytes 5, eosinophils 1, basophils 1, retic- 
nlocytes 0), white blood count 12,000 and hemoglobin 14 grams. Urine 
and Kahn negative. 

The second case gave a history of influenza in 1919 and complained 
of malaise, nervousness, headache, and one recent spell of nausea and 
vomiting. The physical examination data were essentially negative. 
The red blood count was 4,800,000 (differential: neutrophils segmented 


51 


63, neutrophils bands 4, lymphocytes 31, monocytes 2, eosinophils 0, 
basophils 0, reticulocytes 0), white blood count 8,400 and hemoglobin 
15 grams. Urine and Kahn negative. 

The third case gave a history of influenza in 1918 and pleurisy in 
1946, with symptoms of dizziness and irritability. The physical 
examination was essentially negative. The red blood count was 4,- 
900,000 (differential: neutrophils segmented 52, neutrophils bands 2, 
lymphocytes 40, monocytes 3, eosinophils 2, basophils 1, reticulocytes 
0), white blood count 11,500 and hemoglobin 15 grams. Urine nega¬ 
tive and Kahn unknown. 

Long-Bone X-ray Films 

The X-ray films of the long bones of the left forearm were examined 
for structural changes, such as increased density, narrowing of the 
marrow cavity, increased thickening or roughening along the areas 
where ligamentous attachments would be expected and any changes 
in the bony structure itself. It was concluded that such abnormal 
changes were not present. 


LABORATORY 


Blood Test for Syphilis 

There were nine blood specimens which were reported to have posi¬ 
tive serologic tests for syphilis and two reported as doubtful. The 
rate among white males was 1.6 percent and among colored males 
23.8 percent, or 2.7 percent of all males. There were no positive tests 
at plant C while the other three plants each had 2.2 percent with 
positive reports. 

Hemoglobin Determination 

The largest percentage of workmen with 16 grams or over of hemo¬ 
globin per 100 cubic centimeters of blood was found among those 
who were working in the plant using the greater amount of sodium flu¬ 
oride and lowest in the control plant. A greater relative number of 
workers in the younger age group (under 45 years) and among those 
who had spent less than 10 years in open-hearth work, had hemo¬ 
globin levels of 16 grams or above. In general, hemoglobin levels 
fell within normal limits and no sodium fluoride effect was demon¬ 
strated. (See appendix, table E.) 

Red and White Blood Cell Counts 

White blood cell counts of 11,000 or more were found less com¬ 
monly in the plant using the greater amount of sodium fluoride and 


52 


most often in the plant which had used sodium fluoride in the past. 
1 he differential blood count was normal in all cases except three which 
had eosinophilia. (Persons with 10 or more percent eosinophils were 
considered excessive.) The highest eosinophil count was 26 percent 
but the history and physical findings indicate that asthma was the 
cause of this. No abnormal or immature white blood cells were noted. 
1 he morphology of the red blood cells was within normal limits and 
no stippling or other toxic effect was noted. (See appendix, tables 
F and G.) 

Urinalysis 

Albuminuria was found in only four workers: One in the plant using 
the smaller amount of sodium fluoride and three in the plant which 
used the larger amount of sodium fluoride. This is a small percentage 
and may be coincidental in its occurrence in the plants using sodium 
fluoride. 

Glycosuria was found in two workmen employed in the control 
plant. It was found in one worker who also had albuminuria, in the 
plant using the larger amount of sodium fluoride. 

Fluorides in Urine 

The data indicate that the urinary levels resulting from the ex¬ 
amination of 38 specimens are within normal limits, thus correlating 
quite well with the findings revealed by physical examination. 


SUMMARY OF MEDICAL FINDINGS 

1. In the course of the investigation the following symptoms were 
considered to be most significant and commonly found. The most 
common were cough and upper respiratory complaints, such as hoarse¬ 
ness, sore throat, and congestion of the nose. Burning, watering, and 
scratching sensations of the eyes were occasionally encountered. Very 
temporary symptoms, such as sneezing, cough, gagging, and choking 
occurred in the presence of fume, smoke, and dust. Workmen of 
the control plant complained of cough more often than those exposed 
to flupride. Nausea and vomiting were occasionally reported. Symp¬ 
toms frequently persisted for a period of from 5 to 10 minutes. Occa¬ 
sionally they persisted for an hour or so, and very infrequently for as 
long as 24 hours. Inquiry was made concerning the classical symp¬ 
toms commonly associated with fluorosis. These were not found in 
significant numbers. 

2. The nutrition, development, color, posture, and gait were within 
normal limits. Joint function was good and no rigidity or atrophy 
of the muscles was noted. 


53 


3. Conjunctivitis and corneal opacities were infrequent and were 
not associated with sodium fluoride exposure. The increased opacity 
of the lens was directly related to age. 

4. The nasal mucosa occasionally showed slight inflammation but 
no septal perforations were present. 

5. Pharyngitis alone was found most often in the control plant. 

6. No pulmonary findings were related to sodium fluoride exposure. 

7. Eleven and seven-tenths percent of all the workers examined had 
essential hypertension. Incidence of suspected hypertensive heart 
disease was 9 percent in the control group, which w T as about twice as 
much as the highest other group. No cardiovascular change was ap¬ 
parent as the result of exposure to sodium fluoride. 

8. Only a few cases suggesting the possibility of fluoride dermatitis 
were seen. Irregularities and mottling of the nails as described by 
Spira were not found. 

9. The lung-field markings compare favorably with those of other 
industrial groups previously studied. No change was seen to occur as 
a result of exposure to sodium fluoride. There were two cases of 
silicosis in the first degree and four considered to be approaching early 
silicosis. Two cases were presumed to be in a moderate to advanced 
stage of active pulmonary tuberculosis, and three in a minimal stage 
of inactive pulmonary tuberculosis. 

10. The arm-bone X-rays were carefully examined and no signs of 
fluorosis could be found. 

11. Laboratory examinations of the blood and urine revealed no 
toxic effect. Urinary fluoride levels were below levels which had been 
shown safe in experimental work. 


CONCLUSIONS FROM MEDICAL FINDINGS 

1. Fume, smoke, and dust encountered at the open hearths induce 
an upper respiratory symptom complex which may be irritating and 
annoying. 

2. According to the data on symptoms by plants, there is an inverse 
relationship of the symptomatology to the exposure to sodium fluoride. 

3. No severe pharyngeal damage results from exposure to sodium 
fluoride. A slight degree of pharyngitis may possibly be caused by 
sodium fluoride, tar smoke, or sulfur dioxide fumes. It is difficult to 
separate the effects of these three environmental factors. 

4. On a basis of physical and X-ray findings, there were no definite 
changes attributable to sodium fluoride. 


54 


Oral Findings 


INTRODUCTION 

Sodium fluoride has become increasingly important to the oral health 
of mankind since the discovery of this substance as an agent capable 
of reducing caries activity in the teeth of children. Exposure to 
sodium fluoride during adult life has not been demonstrated as bene¬ 
ficial in caries prevention. 

Certain of the fluoride substances such as hydrofluoric acid (HF) 
and hydrofluosilicic acid (H 2 SiF 6 ) produce characteristic lesions of 
the soft oral tissues. The lips, gingivae, oral mucosae, and tongue 
may show inflammatory reaction to exposure of these acids. Sodium 
fluoride (NaF) does not produce any characteristic open lesions in 
the mouth as shown by experimental data. Cryolite (Na 3 AlF 6 ), an¬ 
other sodium salt of fluorine, does not produce any oral manifestations 
of soft tissue change. However, Roholm 1 and other investigators have 
shown that total fluoride content pf tooth substance in the jaws is in¬ 
creased in adults exposed to sodium fluoride (NaF) and cryolite 
(Na 3 AlF 6 ). Bone tissue of the jaws, which is capable of constant in¬ 
terchange of calcium salts, increases in fluoride content by the deposi¬ 
tion of the fluoride in some form within the bony structure. Explana¬ 
tion for the increased fluoride concentrations in tooth structure is 
based on the formation of secondary dentin within the pulpal cavity 
and by development of hypercementosis of the tooth roots during pro¬ 
longed periods of exposure to sodium fluoride (NaF). 

In this survey the employees were exposed to varied concentrations of 
sodium fluoride during their daily work. The problem was to ascer¬ 
tain whether or not the levels of exposure to sodium fluoride (NaF) 
were sufficient to cause any deleterious effect in the oral tissues and 
structures. 


CLINICAL ORAL EXAMINATION 

Clinical oral examination consisted of a detailed inspection of all 
oral tissues and structures by the examining dental officers. The lips, 

1 Roholm, Kuj: Flourine Intoxication. II. K. Lewis & Co., London, 1937. 


55 



tongue, palate, uvula, oral mucosae, teeth, and supporting structure, 
salivary glands and ducts, and the mandible were inspected and all 
observations were recorded. 

Kadiodontic films were used as a diagnostic aid in completion of the 
oral inspection. Two intra-oral bite-wing exposures (Eastman 
1XF43) and a lateral 5- by 7-inch extra-oral view of the left mandible 
were made in the majority of employees. 

All oral findings, whether normal or abnormal, were recorded on an 
examination form developed for use in this survey. The individuals 
who were found to have abnormal oral conditions were informed of 
their abnormalities and advised to have them corrected as soon as 
possible. 


GENERAL FINDINGS 

Accrued defects of the oral tissues and structures considered to be 
nonoccupational in origin were classified in this category. The fre¬ 
quency with which these abnormal conditions appeared among the 
350 male employees surveyed compared with 1,514 male cemented 
tungsten carbide workers is shown in table 13. The range of ac¬ 
crued oral defects in this population is similar to that observed in 
other industrial and nonindustrial populations. 


SPECIFIC FINDINGS 

The findings in this category indicate that factors present in the 
environment cause certain tissue reactions. Tissue response to inter¬ 
mittent or constant irritants is characterized by hyperemia, observed as 
an increase in color intensity, and keratosis or a characteristic thicken¬ 
ing of the mucous membranes. The degree of hyperemia and keratosis 
is dependent on the severity of tissue reaction and constancy of the 
irritant factor or factors. Comparison of clinical observations 
among the groups examined shows a course of tissue change which 
occurred in varied periods of exposure. 

Clinical findings were recorded with the knowledge that many fac¬ 
tors which may have influenced those findings were present in the 
environment, either at a specific occupation or in a combination of 
several occupations. 

Table 14 shows that inflammation was more frequent among the 
males working in plants which used sodium fluoride than in the plants 
which did not use this substance. This was observed for each of the 
oral tissue groups. No consistent differences were noted for keratosis 
or neoplasm. 


56 


Table 13 .—Comparison of the incidence oj abnormalities in specified oral 
tissues and structures among male workers in the open-hearth department 
of the steel industry and in the cemented tungsten carbide industry 


Oral tissues or structures 

Open-hearth 

workers 

Cemented 

tungsten 

carbide 

workers 3 


Number 

Percent 

Num¬ 

ber 

Percent 

Lips___.__ 

93 

26.6 

205 

13.5 

Tongue..._...... 

96 

27.4 

149 

9.8 

Oingivae....._.... . _ 

267 

76.3 

1,153 

76.2 

Oral mucous membrane _____ 

185 

52.9 

746 

49.3 

Palate___ 

149 

42.6 

461 

30.5 

Teeth: 

Caries '.... 

155 

52.7 

869 

68.2 

Calculus 2 ...._... 

195 

78.3 

781 

61.3 

Attrition K . _ ... 

40 

13.6 

124 

9.7 



1 Based on number of persons with teeth. 

2 Based on number of persons with teeth minus those with no information on this item. 

3 Unpublished data. 


INTERPRETATION OF FINDINGS 

Substances found to exist in the occupational environment were 
sodium fluoride, anthracene, sulfur dioxide, ferric oxide, quartz, dolo¬ 
mite, and slag dust. Therefore, the hard and soft tissues of the oral 
cavity were exposed to chemical as well as mechanical factors. 

Individuals exposed to high intensity of radiant heat arising from 
the face of open ladles and ingots filled with molten metal show an 
increase in the abnormality of the lip mucosae. The drying (desiccat¬ 
ing) effect of this exposure contributed to formation of superficial 
fissures, with or without hemorrhage, and keratoses. Low-grade sec¬ 
ondary infections were observed on the lips of some employees. Ab¬ 
normalities of the lips appear to increase after 55 years of age. Table 
15 shows that the percentage with abnormalities of the velum (soft 
tissue of the posterior of the mouth) and uvula (the small tissue 
appendage in the posterior mouth) was high in all groups examined, 
being greater in the sodium fluoride-using plants (A and C) than in 
the nonsodium fluoride-using plants (B and D). The percentages for 
these two groups are 95.2 and 57.7, respectively. Age does not appear 
to affect the incidence of this condition. It cannot be stated with 
certainty that the great difference in prevalence of this condition was 
due to the presence of, or exposure to, sodium fluoride. 

Attempted correlation of this specific finding with other physical 
findings did not provide sufficient information to form any definite 
conclusions. 

Review of the roentgenographs fails to show any conditions of 
pathosis occurring in the bone which may be associated with exposure 
to sodium fluoride dust and fume. 


57 



















Table 14. —Percentage oj male workers in the open-hearth department oj 4 
steel plants with inflammation, keratosis and neoplasm in specified oral 
tissues or structures , grouped according to plants using sodium fluoride and 
plants not using sodium fluoride 


Oral tissues or structures 

Pathological conditions 

Inflammation Keratosis Neoplasm 

NaF 

plants 

Non- 

NaF 

plants 

NaF 

plants 

Non- 

NaF 

plants 

NaF 

plants 

Non- 

NaF 

plants 




Number 




2 

1 

10 

24 

0 

2 

Tongue _ _ _ 

19 

5 

1 

1 

14 

1 

0 

2 

Gingivae. _ _ _ 

142 

90 

5 

0 

Oral mucous membrane. _ _ 

58 

20 

03 

51 

0 

1 

Palate_ 

44 

11 

28 

32 

4 

0 

U vula and velum_ 

177 

90 

0 

0 

0 

3 




Percent 



Lips. _ _ 

1.1 

0.6 

8.0 

14. 7 

0.0 

1. 2 

Tongue . _ 

10. 2 

3. 1 

.5 

.0 

.5 

1.2 

Gingivae. _ _ __ 

75.9 

58.9 

2.7 

8. 0 

0 

0 

Oral mucous membrane. _ 

31.0 

12.3 

33. 7 

31.3 

0 

. 6 

Palate _ _ 

23. 5 

0. 7 

15.0 

19.6 

2. 1 

0 

Uvula and velum_ 

94. 7 

55. 2 

0 

0 

3.2 

1.8 


Table 15 .—Percentage oj male workers in the open-hearth department oj 4 
steel plants with abnormalities in specified tissues or structures, grouped 
according to plants using sodiutn fluoride and plants not using sodium 
fluoride 


Plants 

Total 
per¬ 
sons ex¬ 
amined 

Per¬ 

sons 

edentu¬ 

lous 

Oral tissues or structures 

Lips 

Tongue 

Gingi¬ 

vae 

Oral 

mucous 

mem¬ 

brane 

Palate 

U vula 
and 
velum 

Teeth 
(car¬ 
ies) 1 


Number 

Total_ 

350 

56 

93 

96 

207 

185 

149 

272 

155 

NaF_ 

187 

25 

49 

39 

154 

113 

94 

178 

81 

Non NaF_ 

163 

31 

44 

57 

113 

72 

55 

94 

74 


Percent 

Total. _ _ 

100. 0 

16. 0 

20. 0 

27. 4 

76. 3 

52.9 

42. 6 

77. 7 

52. 7 

NaF_ 

100. 0 

13. 4 

26.2 

20. 9 

82.3 

00. 4 

50.3 

95.2 

50.0 

Non NaF_ 

100. 0 

19. 0 

27.0 

35. 0 

09.3 

44.2 

33.7 

57.7 

56. 1 


1 Percentages based on number of persons with teeth. 


Heavy concentrations of dust in this occupational environment as 
shown by the environmental study, may account for the high prev¬ 
alence of premature attrition in the teeth of men in the younger age 
groups. 


58 
























































































SUMMARY OF ORAL FINDINGS 


1. Three hundred and fifty workers of the open-hearth divisions in 
four steel plants were given clinical oral examinations. 

2. The outstanding soft-tissue abnormality in this group of men 
was inflammation of the uvula and velum (soft palate). 

3. The outstanding hard tissue abnormality was premature attri¬ 
tion of occluding tooth surfaces. Attrition did not vary much in 
incidence among the four groups examined. 

4. Roentgenograms of the posterior teeth (bite-wings) and left 
lateral jaw (5- by 7-inch exposure) were obtained. 

CONCLUSIONS FROM ORAL FINDINGS 

1. Exposure to abrasive dust caused premature attrition of the oc¬ 
cluding tooth surfaces allowing for decrease in vertical dimension of 
jaw relationship. 

2. Repeated exposure to irritant factors in the occupational en¬ 
vironment may produce tissue thickening on vulnerable areas of the 
oral mucosae. 

3. Exposure to sodium fluoride had little or no disabling effect on 
the tissues and structures of the oral cavity. Sodium fluoride did 
not produce demonstrable tissue necrosis when introduced into the 
oral cavity in atmospheric concentrations as found in the occupational 
environments investigated. However, sodium fluoride in combination 
with other fumes and dusts may be a contributing factor in produc¬ 
ing soft-tissue inflammation in the oral cavity. 

4. The high incidence of oral abnormalities found in this group 
of male open-hearth workers places the oral health status of this 
population at a low level. 

5. Inflammatory condition of the exposed mucosae indicates that 
tissue irritation by mechanical action, as well as chemical action, was 
possibly due to environmental contaminants. 

RECOMMENDATIONS FROM ORAL FINDINGS 

1. An industrial oral health service program might be developed in 
each of the four plants in which employees were examined. These 
programs would contribute much to raise the oral health level in a 
majority of the employees. 

2. Protection of employees’ oral tissues and structures may be ac¬ 
complished by the use of a lightweight face mask which would filter 
the environmental air, thereby reducing the amount of abrasive dusts 
and particles of chemical substances which may be inhaled by way 
of the oral cavity. 


59 


Acknowledgments 

It is a pleasure to acknowledge the splendid cooperation of the 
officials and men of the plants studied and of the officials and members 
of the United Steelworkers of America, CIO. Special acknowledg¬ 
ment is made to the company for making available certain space, 
services, material, and information for the furtherance of the study. 

The Ohio State Board of Health rendered valuable aid by perform¬ 
ing the serodiagnostic tests for syphilis. 

Acknowledgment is also made to Mr. V. B. Perone, who served as 
medical technician of the field party, and to Mr. D. E. Bushing, Mrs. 
Betty Flick, Mr. Irving May, and Mr. N. A. Talvitie, of this Division, 
who cooperated in the performance of necessary chemical analyses. 

Dr. T. Hilbish and his associates in the Tuberculosis Control Divi¬ 
sion, Bureau of State Services, reviewed chest roentgenograms that 
showed evidence of pulmonary tuberculosis and other chest diseases. 

The entire stafi of the Industrial Hygiene Division contributed in 
many ways. Miss M. E. Hook, who was responsible for the coding 
of the data and the statistical compilations, assisted in the editorial 
work. 


60 


Appendix Tables 


1 able A .—Previous occupation of male open-hearth workers in 4 steel plants 

according to plant 


Previous occupation 

Number 

Percent 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total_ 

350 

48 

63 

139 

100 

100. 0 

1(K). 0 

100.0 

100. 0 

100.0 

None_ 

35 

5 

3 

18 

9 

10.0 

10. 4 

4.8 

12.9 

9.0 

Agriculture, forestry, and fisheries only 

37 

4 

7 

13 

13 

10.6 

8.3 

11. 1 

9. 4 

13. 0 

Agriculture, forestry, fisheries, and 











trade or service... 

20 

1 

3 

6 

10 

5.7 

2.1 

4.8 

4.3 

10. 0 

Trade or service only_ 

88 

10 

12 

52 

14 

25. 2 

20. 8 

19. 0 

37. 4 

14. 0 

Mining or quarrying_ 

33 

7 

6 

9 

11 

9. 4 

14. 6 

9.5 

6.5 

11.1) 

Foundry ____ 

IK 

2 

6 

5 

5 

5. 1 

4. 2 

9. fi 

3.6 

5. 0 

Other dusty trades... 

18 

6 

2 

4 

6 

5. 1 

12.5 

3.2 

2.9 

6. 0 

Manufacturing industry 

8 

1 

4 

0 

3 

2.3 

2. 1 

6. 4 

0 

3.0 

All other__ 

93 

12 

20 

32 

29 

26.6 

25. 0 

31.7 

23. 0 

29.0 


Table B .—Distribution of male open-hearth workers in 4 steel plants by 
percent weight deviation from the average weight of men of their height 
and age according to life insurance tables , by plant 



Number 

Percent 

Percent weight deviation from average 











Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

14 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

I) 

Total .. . 

322 

46 

58 

127 

91 

100.0 

1(H). 0 

100.0 

1(H). 0 

100+ 












25 to 34 below .... 

3 

0 

0 

1 

2 

0.9 

0 

0 

0.8 

2.2 

15 to 24 below 

20 

3 

2 

i 

8 

6.2 

6.5 

3.4 

5.5 

8.8 

5 to 14 below 

77 

8 

16 

31 

22 

23.9 

17.4 

27.6 

24.4 

24.2 

±5___ 

100 

20 

11 

43 

26 

31. 1 

43.5 

19.0 

33.9 

28.5 

5 to 14 above ...-.. 

68 

7 

15 

29 

17 

21.1 

15 

25.9 

22.8 

18.7 

15 to 24 above__ 

38 

7 

9 

8 

14 

11.8 

15.2 

15.5 

6.3 

15.4 

25 to 34 above 

11 

1 

4 

6 

0 

3.4 

2.2 

6.9 

4.7 

0 

35 or more above... .— 

5 

0 

1 

2 

2 

1.6 

0 

1.7 

1.6 

2.2 

Moan (percent) 

+2.2 
13 3 

+2.2 

11.5 

+5.0 

13.9 

+ 1.8 
12.9 

+ 1.0 
13.9 






Standard damnation (percent! 














61 








































































Table C .—Mean systolic and diastolic blood pressures of male open-hearth 
workers in 4 steel plants according to age and plant 


Age (years) 

Total 

Plant A 

PlantB 

Plant C 

Plant D 


Systolic blood pressure 

Total_ _ 

132. 7 

128.4 

133.0 

131.9 

135. 7 

Under 25.. _ 

121.7 

0 

90.0 

121.8 

125. 5 

25 to 29_ 

124. 1 

118.0 

123. 2 

124. 0 

128. 8 

30 to 34_ 

126.0 

128. 5 

123. 8 

125. 3 

128.8 

35 to 39_ 

126.9 

125.2 

116.6 

132. 2 

119. 7 

40 to 44_ __ . _ 

130.7 

134. 6 

148.8 

126. 0 

120.5 

45 to 49...__ 

132. 1 

126.2 

130. 7 

126. 0 

141. 2 

50 to 54_ 

138.8 

128.7 

138. 4 

138.9 

140.6 

55 to 59_ 

148.8 

118.7 

161.5 

152.0 

148.5 

00 to 64_ 

143.5 

124.0 

152.0 

156.0 

132. 4 

65 or over_ _ .. ___ _ _ 

152. 2 

160.0 

138.0 

145. 0 

163. 5 


Diastolic blood pressure 

Total_ 

84.0 

83.2 

83.4 

83.9 

85.0 

Under 25_ _ 

77.3 

0 

50.0 

77.5 

80.5 

25 to 29_ . 

80.5 

78.0 

76. 4 

81.3 

82.8 

30 to 34_ 

81.7 

80.3 

78 9 

82.6 

83.2 

35 to 39_ 

81. 7 

82. 0 

78.6 

82.8 

80.6 

40 to 44_ 

85. 4 

87.1 

92. 0 

84.6 

80.7 

45 to 49_ 

85.4 

85. 7 

83.6 

82.8 

88.0 

50 to 54_ 

85.9 

80.0 

85.9 

88.6 

84.4 

55 to 59_ .... 

90. 4 

74-7 

96.0 

91. 1 

91.3 

60 to 64_ 

88.2 

84.0 

91.3 

92.0 

84.0 

65 or over_ _ .. ... _ _ 

82. 1 

70.0 

78.0 

78.7 

89.5 


Note. —Figures in italics are based on less than 5 persons 


62 














































Table D. i ypc of lung-field markings observed in chest roentgenograms of 
male open-hearth workers in the steel industry according to plant and age 


Type of lung-field marking 


Numfcx 

r 


Percent 

To¬ 

tal 

riant 

A 

Plant 

B 

Plant 

C 

Plant 

I) 

To¬ 

tal 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

L) 






All ages 





Total__ 

318 

48 

58 

123 

89 

100.0 

100.0 

100.0 

100.0 

100.0 

Normal or first degree linear 

97 

24 

11 

34 

28 

30. 5 

.50. 0 

19.0 

27 6 

31 5 

Second degree linear . 

18-1 

24 

38 

74 

48 

57. 9 

50 n 

65 5 

60 2 

53 9 

First and second degree granular 

35 

0 

9 

14 

12 

1 l.n 

0 

15. 5 

11 4 

13 5 

Nodular or conglomerate 

2 

0 

0 

1 

1 

.6 

0 

0 

.8 

1.1 


Under 40 years 

Total... 

139 

14 

23 

76 

26 

100.0 

1 (H). 0 

100.0 

100.0 

100.0 

Normal or first degree linear 

63 

8 

9 

28 

18 

45.3 

57.1 

39.1 

30 s 

69. 2 

Second degree linear . 

67 

6 

12 

42 

7 

48 . 2 

42. 9 

52. 2 

55.3 

20 9 

First and second degree granular 

9 

0 

2 

6 

i 

6 5 

0 

8 . 7 

7 <* 

3. 9 

Nodular or conglomerate 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 


40 to 49 yeai s 

Total.. 

81 

26 

16 

14 

25 

100.0 

1(H). 0 

100.0 

100.0 

100.0 

Normal or first degree linear. . . 

23 

14 

2 

2 

5 

28.4 

.53.8 

12.5 

14.3 

20 ii 

Second degree linear . . 

47 

12 

12 

8 

15 

58. 0 

46. 2 

75. 0 

57. 1 

60.0 

First and second degree granular. 

II 

0 

2 

4 

5 

13. 6 

0 

12.5 

28.6 

20.0 

Nodular or conglomerate.. 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 


50 years nr over 


Total.. 

98 

* 

19 

33 

38 

100.0 

100 . 0 

100.0 

100.0 

100.0 

Normal or first degree linear. _ 

11 

2 

0 

4 

5 

11.2 

25.0 

0 

12 . 1 

13.2 

Second degree linear. ____ 

70 

6 

14 

24 

20 

71.4 

75.0 

73.7 

72.7 

08. 4 

First and second degree granular_ 

15 

0 

5 

4 

6 

15.3 

0 

26.3 

12 . 1 

15.8 

Nodular or conglomerate.. 

2 

0 

0 

1 

1 

2 . 1 

0 

0 

3.1 

2.6 


Table E .—Hemoglobin values oj male open-hearth workers in 4 steel plants 

according to plant 


Hemoglobin grams per 100 cubic centi¬ 
meters of blood 

Num her 

Percent. 

Total 

Plant 

A 

Plant 

H 

Plant 

C 

Plant 

D 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total.. 

350 

48 

63 

139 

100 

100.0 

100.0 

100.0 

100.0 

100.0 

13________ 

4 

0 

0 

2 

2 

1.1 

0 

0 

1.4 

2.0 

14...____ 

39 

5 

3 

15 

16 

11.2 

10.4 

4.8 

10.8 

16.0 

15___ 

102 

16 

22 

35 

29 

29.2 

33.3 

34.9 

25.2 

29.0 

16.... 

117 

24 

24 

45 

24 

33.4 

50.0 

3s 1 

32.4 

24.0 

17... 

74 

3 

14 

38 

19 

21.1 

6.3 

22.2 

27.3 

19.0 

18..... 

14 

0 

0 

4 

10 

4.0 

0 

0 

2.9 

10.0 

Mean 

15. 7 

15.5 

15.8 

15.8 

15.7 






Standard deviation 

1.1 

0.8 

0.8 

1.1 

1.3 





















































































































































Table F .—Red blood count (millions per mm. ) among male open-hearth 
workers in 4 steel plants according to plant 


Red blood count in millions per mm 3 

Number 

Percent 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total _ 

350 

48 

63 

139 

100 

100.0 

100.0 

100.0 

100.0 

100.0 

4.2_ 

1 

0 

0 

1 

0 

.3 

0 

0 

.7 

0 

4.3_ 

1 

0 

0 

1 

0 

.3 

0 

0 

.7 

0 

4.4_ 

3 

0 

1 

1 

1 

.9 

0 

1.6 

.7 

1.0 

4.5_ 

3 

0 

0 

2 

1 

.9 

0 

0 

1.4 

1.0 

4.6__ 

8 

1 

0 

4 

3 

2.3 

2.1 

0 

2.9 

3.0 

4.7_ 

24 

3 

2 

7 

12 

6.9 

6.2 

3.2 

5.0 

12.0 

4.8_ 

59 

6 

12 

23 

18 

16.8 

12.5 

19.0 

16.6 

18.0 

4.9_ 

58 

7 

11 

24 

16 

16.6 

14.6 

17.5 

17.3 

16.0 

5.0_ 

80 

12 

12 

34 

22 

22.8 

25.0 

19. 0 

24.5 

22.0 

5.1_ .... .... .. 

68 

6 

14 

30 

18 

19.4 

12.5 

22.2 

21.6 

18.0 

5.2____ 

34 

7 

9 

11 

7 

9.7 

14.6 

14. 3 

7.9 

7.0 

5.3_ 

8 

4 

2 

1 

i 

2.3 

8.3 

3.2 

.7 

1.0 

5.4___ 

3 

2 

0 

0 

i 

.8 

4.2 

0 

0 

1.0 

Mean (millions/mm 3 ) 

5.0 

5.0 

5.0 

4.9 

4.9 













Table G .—Distribution of total leucocyte count among male open-hearth 
workers in 4 steel plants according to plant 


Number 


Percent 


Total leucocyte count per mm 3 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

I) 

Total 

Plant 

A 

Plant 

B 

Plant 

C 

Plant 

D 

Total_ 

350 

48 

63 

139 

100 

100. 0 

100.0 

100. 0 

100.0 

100.0 

Less than 5,000-..__ 

1 

1 

0 

0 

0 

0.3 

2. 1 

0 

0 

0 

5,000_ . ... ___ _ 

12 

3 

0 

4 

5 

3.4 

6. 2 

0 

2.9 

5.0 

5,500_ .... _ 

5 

1 

1 

2 

1 

1. 4 

2. 1 

1. 6 

1.4 

1.0 

6,000....... .. . _ .__. .. 

34 

6 

0 

22 

6 

9. 7 

12.5 

0 

15.8 

6.0 

6,500. . .. ...... _ 

15 

0 

4 

5 

6 

4.3 

0 

6. 4 

3.6 

6.0 

7,000_ . _ .... _ 

35 

2 

4 

16 

13 

10. 0 

4. 2 

6. 4 

11.5 

13. 0 

7,500_ __ 

16 

5 

4 

4 

3 

4.6 

10. 4 

6.3 

2.9 

3.0 

8,000. ... . .. .. _ 

52 

7 

5 

28 

12 

14. 9 

14. 6 

7.9 

20.2 

12. 0 

8,500. _ _ 

31 

4 

13 

7 

7 

8.9 

8.3 

20.6 

5. 0 

7.0 

9,000.. . ............ 

32 

6 

3 

15 

8 

9. 1 

12.5 

4.8 

10.8 

8.0 

9,500_ . 

15 

0 

6 

4 

5 

4.3 

0 

9.5 

2.9 

5.0 

10,000 .. ........... 

25 

4 

4 

11 

6 

7. 1 

8.3 

6.3 

7.9 

6.0 

10,500 ............... _ 

14 

1 

4 

3 

6 

4.0 

2. 1 

6.3 

2. 2 

6.0 

11,000 .. _ __ ... 

31 

6 

10 

5 

10 

8.9 

12.5 

15.9 

3. 6 

10.0 

11,500. . _ . . 

11 

1 

2 

4 

4 

3. 1 

2. 1 

3.2 

2.9 

4.0 

12,000 _ _ _ 

7 

1 

0 

3 

3 

2. 0 

2.1 

0 

2.2 

3.0 

12,500_ 

6 

0 

3 

2 

1 

1.7 

0 

4.8 

1.4 

1.0 

13,000_ 

3 

0 

0 

1 

2 

.8 

0 

0 

.7 

2.0 

13,500_ 

2 

0 

0 

2 

0 

.6 

0 

0 

1. 4 

0 

14,000_ 

2 

0 

0 

1 

1 

.6 

0 

0 

. 7 

1.0 

14,500_ _ 

0 

0 

0 

0 

0 

0 

0 

0 

0 

0 

15,000_ 

1 

0 

0 

0 

1 

.3 

0 

0 

0 

1.0 

Mean _ . 

8, 825 

8, 510 

9, 400 

8, 535 

9, 015 






Standard deviation_ 

2, 000 

1,940 

1,650 

2, 000 

2, 165 













64 


U. S. GOVERNMENT PRINTING OFFICE 


1948 






















































































































































































































































































































































































































































































